Skip to main content
NCBI home page
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 1983 Nov;36(11):1207–1214. doi: 10.1136/jcp.36.11.1207

A review of the current status and techniques of allogeneic bone marrow transplantation for treatment of leukaemia.

H G Prentice
PMCID: PMC498532  PMID: 6355192

Abstract

Bone marrow transplantation is now an accepted component in the overall therapy of acute and chronic (myeloid) leukaemia for some selected patients. Some of the obstacles to success have been partially overcome. Many advances in supportive care have been made. Pneumocystis carinii and herpes simplex infections are preventable. Effective decontamination of the gastrointestinal tract for bacteria and fungi is now readily achievable and may have reduced the risk of serious systemic infections. New antibiotics which, in combination, are effective in life-threatening infections are under study. Recent developments in the prevention or amelioration of graft versus host disease (GvHD) have included T lymphocyte depletion in the donor marrow and the use of the fungal polypeptide cyclosporin A. Less than 10% of patients would now be expected to succumb to this complication. Outstanding problems remaining to be resolved are the improvement in the antileukaemic conditioning prior to transplantation and the prevention or treatment of cytomegalovirus infection in the seropositive recipient. This infection can cause pneumonitis and is currently the single most frequent transplant related cause of mortality.

Full text

PDF
1207

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Badger C., Buckner C. D., Thomas E. D., Clift R. A., Sanders J. E., Stewart P. S., Storb R., Sullivan K. M., Shulman H., Flournoy N. Allogeneic marrow transplantation for acute leukemia in relapse. Leuk Res. 1982;6(3):383–387. doi: 10.1016/0145-2126(82)90101-1. [DOI] [PubMed] [Google Scholar]
  2. Barrett A. J., Kendra J. R., Lucas C. F., Joss D. V., Joshi R., Desai M., Jones K. H., Phillips R. H., Rogers T. R., Tabara Z. Bone marrow transplantation for acute lymphoblastic leukaemia. Br J Haematol. 1982 Oct;52(2):181–188. doi: 10.1111/j.1365-2141.1982.tb03879.x. [DOI] [PubMed] [Google Scholar]
  3. Blacklock H. A., Gilmore M. J., Prentice H. G., Hazlehurst G. R., Evans J. P., Ma D. D., Knight C. B., Hoffbrand A. V. ABO-incompatible bone-marrow transplantation: removal of red blood cells from donor marrow avoiding recipient antibody depletion. Lancet. 1982 Nov 13;2(8307):1061–1064. doi: 10.1016/s0140-6736(82)90003-4. [DOI] [PubMed] [Google Scholar]
  4. Borel J. F., Feurer C., Magnée C., Stähelin H. Effects of the new anti-lymphocytic peptide cyclosporin A in animals. Immunology. 1977 Jun;32(6):1017–1025. [PMC free article] [PubMed] [Google Scholar]
  5. Bryant B. M., Jarman M., Ford H. T., Smith I. E. Prevention of isophosphamide-induced urothelial toxicity with 2-mercaptoethane sulphonate sodium (mesnum) in patients with advanced carcinoma. Lancet. 1980 Sep 27;2(8196):657–659. doi: 10.1016/s0140-6736(80)92703-8. [DOI] [PubMed] [Google Scholar]
  6. Buckner C. D., Clift R. A., Thomas E. D. Bone marrow transplantation: introduction. Leuk Res. 1982;6(3):381–382. doi: 10.1016/0145-2126(82)90100-x. [DOI] [PubMed] [Google Scholar]
  7. Buckner C. D., Clift R. A., Thomas E. D., Sanders J. E., Hackman R., Stewart P. S., Storb R., Sullivan K. M. Allogeneic marrow transplantation for patients with acute non-lymphoblastic leukemia in second remission. Leuk Res. 1982;6(3):395–399. doi: 10.1016/0145-2126(82)90103-5. [DOI] [PubMed] [Google Scholar]
  8. Buckner C. D., Clift R. A., Thomas E. D., Sanders J. E., Stewart P. S., Storb R., Sullivan K. M., Hackman R. Allogeneic marrow transplantation for acute non-lymphoblastic leukemia in relapse using fractionated total body irradiation. Leuk Res. 1982;6(3):389–394. doi: 10.1016/0145-2126(82)90102-3. [DOI] [PubMed] [Google Scholar]
  9. Clift R. A., Buckner C. D., Thomas E. D., Sanders J. E., Stewart P. S., McGuffin R., Hersman J., Sullivan K. M., Sale G. E., Storb R. Allogeneic marrow transplantation for acute lymphoblastic leukemia in remission using fractionated total body irradiation. Leuk Res. 1982;6(3):409–412. doi: 10.1016/0145-2126(82)90105-9. [DOI] [PubMed] [Google Scholar]
  10. Clift R. A., Buckner C. D., Thomas E. D., Sanders J. E., Stewart P. S., Sullivan K. M., McGuffin R., Hersman J., Sale G. E., Storb R. Allogeneic marrow transplantation using fractionated total body irradiation in patients with acute lymphoblastic leukemia in relapse. Leuk Res. 1982;6(3):401–407. doi: 10.1016/0145-2126(82)90104-7. [DOI] [PubMed] [Google Scholar]
  11. Esterhay R. J., Jr, Wiernik P. H., Grove W. R., Markus S. D., Wesley M. N. Moderate dose methotrexate, vincristine, asparaginase, and dexamethasone for treatment of adult acute lymphocytic leukemia. Blood. 1982 Feb;59(2):334–345. [PubMed] [Google Scholar]
  12. Hann I. M., Prentice H. G., Blacklock H. A., Ross M. G., Brigden D., Rosling A. E., Burke C., Crawford D. H., Brumfitt W., Hoffbrand A. V. Acyclovir prophylaxis against herpes virus infections in severely immunocompromised patients: randomised double blind trial. Br Med J (Clin Res Ed) 1983 Aug 6;287(6389):384–388. doi: 10.1136/bmj.287.6389.384. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hann I. M., Prentice H. G., Corringham R., Blacklock H. A., Keaney M., Shannon M., Noone P., Gascoigne E., Fox J., Boesen E. Ketoconazole versus nystatin plus amphotericin B for fungal prophylaxis in severely immunocompromised patients. Lancet. 1982 Apr 10;1(8276):826–829. doi: 10.1016/s0140-6736(82)91874-8. [DOI] [PubMed] [Google Scholar]
  14. Hann I. M., Prentice H. G., Keaney M., Corringham R., Blacklock H. A., Fox J., Gascoigne E., Van Cutsem J. The pharmacokinetics of ketoconazole in severely immunocompromised patients. J Antimicrob Chemother. 1982 Dec;10(6):489–496. doi: 10.1093/jac/10.6.489. [DOI] [PubMed] [Google Scholar]
  15. Henderson E. S., Scharlau C., Cooper M. R., Haurani F. I., Silver R. T., Brunner K., Carey R. W., Falkson G., Blom J., Nawabi I. V. Combination chemotherapy and radiotherapy for acute lymphocytic leukemia in adults: results of CALGB protocol 7113. Leuk Res. 1979;3(6):395–407. doi: 10.1016/0145-2126(79)90036-5. [DOI] [PubMed] [Google Scholar]
  16. Henze G., Langermann H. J., Ritter J., Schellong G., Riehm H. Treatment strategy for different risk groups in childhood acute lymphoblastic leukemia: A Report From the BFM Study Group. Haematol Blood Transfus. 1981;26:87–93. doi: 10.1007/978-3-642-67984-1_13. [DOI] [PubMed] [Google Scholar]
  17. Hickman R. O., Buckner C. D., Clift R. A., Sanders J. E., Stewart P., Thomas E. D. A modified right atrial catheter for access to the venous system in marrow transplant recipients. Surg Gynecol Obstet. 1979 Jun;148(6):871–875. [PubMed] [Google Scholar]
  18. Hughes W. T., Kuhn S., Chaudhary S., Feldman S., Verzosa M., Aur R. J., Pratt C., George S. L. Successful chemoprophylaxis for Pneumocystis carinii pneumonitis. N Engl J Med. 1977 Dec 29;297(26):1419–1426. doi: 10.1056/NEJM197712292972602. [DOI] [PubMed] [Google Scholar]
  19. JACOBSON L. O., SIMMONS E. L., MARKS E. K., ROBSON M. J., BETHARD W. F., GASTON E. O. The role of the spleen in radiation injury and recovery. J Lab Clin Med. 1950 May;35(5):746–770. [PubMed] [Google Scholar]
  20. Körbling M., Fliedner T. M., Calvo W., Ross W. M., Nothdurft W., Steinbach I. Albumin density gradient purification of canine hemopoietic blood stem cells (HBSC): long-term allogeneic engraftment without GVH-reaction. Exp Hematol. 1979 Jul;7(6):277–288. [PubMed] [Google Scholar]
  21. Mayer R. J., Weinstein H. J., Coral F. S., Rosenthal D. S., Frei E., 3rd The role of intensive postinduction chemotherapy in the management of patients with acute myelogenous leukemia. Cancer Treat Rep. 1982 Jul;66(7):1455–1462. [PubMed] [Google Scholar]
  22. Powles R. L., Barrett A. J., Clink H., Kay H. E., Sloane J., McElwain T. J. Cyclosporin A for the treatment of graft-versus-host disease in man. Lancet. 1978 Dec 23;2(8104-5):1327–1331. doi: 10.1016/s0140-6736(78)91971-2. [DOI] [PubMed] [Google Scholar]
  23. Powles R. L., Clink H. M., Spence D., Morgenstern G., Watson J. G., Selby P. J., Woods M., Barrett A., Jameson B., Sloane J. Cyclosporin A to prevent graft-versus-host disease in man after allogeneic bone-marrow transplantation. Lancet. 1980 Feb 16;1(8164):327–329. doi: 10.1016/s0140-6736(80)90881-8. [DOI] [PubMed] [Google Scholar]
  24. Powles R. L., Morgenstern G. R., Kay H. E., McElwain T. J., Clink H. M., Dady P. J., Barrett A., Jameson B., Depledge M. H., Watson J. G. Mismatched family donors for bone-marrow transplantation as treatment for acute leukaemia. Lancet. 1983 Mar 19;1(8325):612–615. doi: 10.1016/s0140-6736(83)91793-2. [DOI] [PubMed] [Google Scholar]
  25. Powles R. L., Morgenstern G., Clink H. M., Hedley D., Bandini G., Lumley H., Watson J. G., Lawson D., Spence D., Barrett A. The place of bone-marrow transplantation in acute myelogenous leukaemia. Lancet. 1980 May 17;1(8177):1047–1050. doi: 10.1016/s0140-6736(80)91497-x. [DOI] [PubMed] [Google Scholar]
  26. Prentice H. G., Blacklock H. A., Janossy G., Bradstock K. F., Skeggs D., Goldstein G., Hoffbrand A. V. Use of anti-T-cell monoclonal antibody OKT3 to prevent acute graft-versus-host disease in allogeneic bone-marrow transplantation for acute leukaemia. Lancet. 1982 Mar 27;1(8274):700–703. doi: 10.1016/s0140-6736(82)92619-8. [DOI] [PubMed] [Google Scholar]
  27. Reisner Y., Kapoor N., Kirkpatrick D., Pollack M. S., Dupont B., Good R. A., O'Reilly R. J. Transplantation for acute leukaemia with HLA-A and B nonidentical parental marrow cells fractionated with soybean agglutinin and sheep red blood cells. Lancet. 1981 Aug 15;2(8242):327–331. doi: 10.1016/s0140-6736(81)90647-4. [DOI] [PubMed] [Google Scholar]
  28. Rodt H., Kolb H. J., Netzel B., Haas R. J., Wilms K., Götze C. B., Link H., Thierfelder S. Effect of anti-T-cell globulin on GVHD in leukemic patients treated with BMT. Transplant Proc. 1981 Mar;13(1 Pt 1):257–261. [PubMed] [Google Scholar]
  29. Santos G. W., Kaizer H. Bone marrow transplantation in acute leukemia. Semin Hematol. 1982 Jul;19(3):227–239. [PubMed] [Google Scholar]
  30. Saral R., Burns W. H., Laskin O. L., Santos G. W., Lietman P. S. Acyclovir prophylaxis of herpes-simplex-virus infections. N Engl J Med. 1981 Jul 9;305(2):63–67. doi: 10.1056/NEJM198107093050202. [DOI] [PubMed] [Google Scholar]
  31. Shulman H., Striker G., Deeg H. J., Kennedy M., Storb R., Thomas E. D. Nephrotoxicity of cyclosporin A after allogeneic marrow transplantation: glomerular thromboses and tubular injury. N Engl J Med. 1981 Dec 3;305(23):1392–1395. doi: 10.1056/NEJM198112033052306. [DOI] [PubMed] [Google Scholar]
  32. Storb R., Epstein R. B., Graham T. C., Thomas E. D. Methotrexate regimens for control of graft-versus-host disease in dogs with allogeneic marrow grafts. Transplantation. 1970 Mar;9(3):240–246. doi: 10.1097/00007890-197003000-00007. [DOI] [PubMed] [Google Scholar]
  33. Storb R., Prentice R. L., Buckner C. D., Clift R. A., Appelbaum F., Deeg J., Doney K., Hansen J. A., Mason M., Sanders J. E. Graft-versus-host disease and survival in patients with aplastic anemia treated by marrow grafts from HLA-identical siblings. Beneficial effect of a protective environment. N Engl J Med. 1983 Feb 10;308(6):302–307. doi: 10.1056/NEJM198302103080602. [DOI] [PubMed] [Google Scholar]
  34. The UCLA Bone Marrow Transplantation Group Bone marrow transplantation with intensive combination chemotherapy/radiation therapy (SCARI) in acute leukemia. Ann Intern Med. 1977 Feb;86(2):155–161. doi: 10.7326/0003-4819-86-2-155. [DOI] [PubMed] [Google Scholar]
  35. Thomas E. D., Clift R. A., Buckner C. D. Marrow transplantation for patients with acute nonlymphoblastic leukemia who achieve a first remission. Cancer Treat Rep. 1982 Jul;66(7):1463–1466. [PubMed] [Google Scholar]
  36. Watson J. G. Problems of infection after bone marrow transplantation. J Clin Pathol. 1983 Jun;36(6):683–692. doi: 10.1136/jcp.36.6.683. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Weiden P. L., Flournoy N., Sanders J. E., Sullivan K. M., Thomas E. D. Antileukemic effect of graft-versus-host disease contributes to improved survival after allogeneic marrow transplantation. Transplant Proc. 1981 Mar;13(1 Pt 1):248–251. [PubMed] [Google Scholar]
  38. Winston D. J., Ho W. G., Howell C. L., Miller M. J., Mickey R., Martin W. J., Lin C. H., Gale R. P. Cytomegalovirus infections associated with leukocyte transfusions. Ann Intern Med. 1980 Nov;93(5):671–675. doi: 10.7326/0003-4819-93-5-671. [DOI] [PubMed] [Google Scholar]
  39. van Dicke KA Hooft J. I., van Bekkum D. W. The selective elimination of immunologically competent cells from bone marrow and lymphatic cell mixtures. II. Mouse spleen cell fractionation on a discontinuous albumin gradient. Transplantation. 1968 Jul;6(4):562–570. doi: 10.1097/00007890-196807000-00009. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES