Journal of Clinical Oncology, Vol 1, 517-531, Copyright © 1983 by American Society of Clinical Oncology
Karnofsky Memorial Lecture. Marrow transplantation for malignant diseases
ED Thomas
Marrow grafting, once undertaken only after failure of all other forms of
therapy, is now the preferred therapy for some malignant diseases.
Chemoradiotherapy and marrow grafting for patients with acute leukemia who
have failed chemotherapy results in cure rates of 10%-30%. For patients
under the age of 50 with acute nonlymphoblastic leukemia transplanted in
first remission, the cure rate is approximately 50% with better results in
younger patients. Marrow grafting is now being explored in a variety of
types of malignant diseases having in common a steep dose-response curve to
therapy, therapy limited by marrow toxicity, and the availability of a
suitable marrow donor. Current research in the field of marrow
transplantation is reviewed and provides a basis for a reasonable
expectation that results of marrow transplantation will continue to
improve. The use of partially matched family members or phenotypically
histocompatibility leukocyte antigen- identical unrelated donors will make
marrow grafting available to a larger fraction of patients. Marrow
grafting, developed for the treatment of malignant disease, has found an
important application to nonmalignant diseases, including immunodeficiency
syndromes, aplastic anemia, and thalassemia and other genetic disorders of
hematopoiesis.
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