The role of autologous bone marrow transplantation in the treatment of malignant disease.

This short review of autologous bone marrow transplantation (ABMT) has a distinct clinical emphasis and concentrates particularly on adult acute leukaemia and lymphoma in which the greatest amount of current clinical experience lies. In the early part of the review we discuss how escalations of dose of chemoradiotherapy might allow ablation of both marrow-derived (leukaemia) and non-marrow-derived disease (lymphoma and solid tumour) provided that haemopoiesis is reintroduced into the host in the form of autologous marrow stem cells, and how cryopreservation techniques have allowed this to proceed. Whilst discussing ABMT in acute leukaemia we describe initial results possibly suggestive of an improvement on current consolidation/maintenance chemotherapy regimens but emphasis that we are dealing only with heterogeneous registry data and not randomised controlled trials. We also suggest that there is no useful data as yet as to the value of purging autologous acute leukaemia marrow. The lymphoma data is described which may suggest a useful role of high dose therapy with ABMT in relapsed disease-timing of ABMT may need to differ profoundly in HD from NHL. Current ABMT data in lymphoma suggests that local relapse at sites of previous disease remain the major problem and emphasises the difficulties of finding satisfactory ablative regimens and timing the selection of patients at particular points in the natural history of their disease. Finally, we emphasise that although solid tumours may numerically represent the largest group of potential candidates for ABMT, the picture in this area remains essentially one of failure to be able to ablate the underlying disease despite increments in chemoradiotherapy and ABMT.