Case Studies

 Case 8.3 Bone marrow transplantation for acute myeloid leukaemia

A 22-year-old man was treated for acute myeloid leukaemia (AML) with cyclical combination chemotherapy, and complete clinical remission was obtained after three courses. However, remission in AML is generally short; half the patients relapse within a year and second remissions are difficult to achieve. Bone marrow transplantation after high-dose chemoradiotherapy is therefore considered in young patients with suitable family members. The brother of this patient was HLA identical and willing to act as a marrow donor. The patient was given cyclophosphamide (120mg/kg) followed by a dose of total body irradiation that is ordinarily lethal. Immediately after irradiation he was given an intravenous transfusion of 10⁹ unfractionated bone marrow cells per kilogram obtained from his brother. He was supported with granulocyte colony-stimulating factor and platelet transfusions during the days of aplasia before engraftment occurred. Methotrexate was administered intermittently to try to prevent GVHD. He was discharged home, well, 7 weeks after transplantation, and remains free of leukaemia 2 years later.