Bone marrow transplants

New indications exploit the immune effects of the transplanted cells

Bone marrow, or haematopoietic stem cell, transplants were originally developed to allow the use of very high dose treatments for malignancies such as leukaemia. Their use was based on the ideathat the high dose treatment might overcome inherent resistance of the malignancy to chemotherapy or radiotherapy. Transplants of stem cells from either the same person (autologous) or another person (allogeneic) are used to repopulate and regenerate the bone marrow, “rescuing” the patient from aplasia. Recently, attention has shifted from the straightforward pursuit of higher doses of cytotoxic drugs to the exploitation of immune effects exerted by allogeneic donor cells. Initial work in autologous transplantation concentrated on showing the safety of the process. Many early studies consisted only of case series, but in the past few years several important randomised trials have been reported, allowing closer definition of the conditions for which bone marrow transplants are useful. These include multiple myeloma, recurrent Hodgkin's disease, and aggressive lymphoma in second remission, for which high dose treatment is routinely given following evidence from randomised trials. 1 2

As the indications for stem cell transplants have been better defined overall activity has fallen. The number of high dose procedures reported to the European Blood …