The use and potential of bone marrow allograft and whole-body irradiation in the treatment of leukemia

A brief history of the clinical application of marrow transplantation based on knowledge gained from ten years work utilizing the dog as an animal model is summarized. The techniques for marrow transplantation, donor selection, and conditioning of the recipient are described. Thirteen of the first 110 endstage leukemic patients who received allogeneic grafts and six of 16 patients who received syngeneic grafts are alive 6-11 years after grafting. Encouraged by the apparent "cure" of leukemia in these poor-risk patients, the Seattle transplant group in 1976 decided to give patients transplants earlier in the course of their disease. Patients with acute lymphoblastic leukemia in second or subsequent relapse were considered to have a poor prognosis. Twenty-two such patients received transplants, with seven surviving in remission 3-5 years later. Nineteen patients with acute nonlymphoblastic leukemia received transplants in first remission and 11 are living in remission 3.5-5.5 years after grafting. The median survival will not be less than 42 months. The problems associated with graft-versus-host disease and recurrence of leukemia and methods aimed at eliminating these problems are discussed.