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Peripheral blood and umbilical cord blood are promising sources of hemopoietic stem cells for autologous as well as allogeneic transplantation. The nature of the progenitors responsible for early marrow reconstitution after transplantation on one hand and for permanent reconstitution on the other hand is getting more precise. Features of the cells responsible for GVHD and of those responsible for GVL effect (graft versus leukemia effect) will soon allow a distinct monitoring of these two activities. Molecular biology will soon permit genetic labelling of the graft and thereby bring more precision for its follow-up and modulation in vivo in the post-graft period. Correction of an autologous transplant by introduction of the adequate gene in the hematopoietic stem cells in case of genetic anomaly at this level, should in the future, as suggested by animal studies, allow permanent correction of genetic disorders in patients autografted according to such a procedure. Finally, introduction of procedure like antisense nucleotides against DNA regions responsible for the malignant proliferation of tumoral cell, could extend the therapeutic possibilities of autograft.

Only in the last decade have autologous grafts begun to be studied extensively. Their most attractive feature is the avoidance of GVHD. However, GVHD has antitumoral effect on residual leukemic cells called "graft versus leukemia" effect and better understanding of this phenomenon explains the higher relapse rate after autologous bone marrow transplantation. New approaches such as cyclosporin--induced GVHD and IL-2 administration after autograft bring great expectations in this field. Colony stimulating factors and harvesting of peripheral stem cells help to reduce the duration of neutropenia. Finally, various techniques for marrow purging and hematopoietic cell isolation should make it possible to eliminate minimal residual disease. Recent results of autologous bone marrow transplantation in various malignancies are discussed.

Allogeneic bone marrow transplantation (BMT) is a therapeutic procedure which has a powerful antileukemic activity in addition to that of high dose radiochemotherapy. Its indications have progressively extended from leukemia to most malignant hemopathies. It allows in some of these disorders to increase the number of cures above that obtained by conventional chemotherapy and in others to cure diseases never curable by chemotherapy. Allogeneic BMT, in addition, found more recently many promising indications in the field of genetic disorders of the cellular systems derived from the hematopoietic stem cell. Autologous BMT (ABMT) is also efficient in the majority of malignant hemopathies. Its efficacy however is limited mainly to that of high dose(s) of radiochemotherapy. The efficacy of ABMT thus appears lower than that of allo BMT but in terms of survival this disadvantage is more or less compensated by its lower lethal toxicity. Its efficacy in comparison with that of conventional chemotherapy is still under study. The lethality induced by BMT itself, the risk of mortality due to the disease, the age of the patient and the degree of resistance of the disease to conventional therapies are, among others, crucial parameters to take into consideration for each specific case and of which will depend the quality and the duration of the patient's survival.

Following three courses of induction chemotherapy, 23 patients with small cell carcinoma of the lung were treated with a late intensive regimen including autologous bone marrow infusion. Thirteen patients received high doses (2 or 3 times the induction chemotherapy dosage) of cisplatin, adriamycin and etoposide. One patient was probably cured, but renal and mucosal toxicity was observed. Three patients treated with adriamycin, etoposide and cyclophosphamide also developed severe mucositis. The seven remaining patients received high doses of cyclophosphamide (100 to 200 mg/kg) and etoposide (750 to 1000 mg/m2); responses were obtained with moderate toxicity. The long-term survival is not yet known. The usefulness of bone marrow infusion cannot be determined without further studies.

Adoptive immunotherapy of cancer consists of using interleukin-2 to induce the formation of lymphokine-activated killer (LAK) cells which are toxic to tumoral cells. Six patients, 3 with hypernephroma and 3 with melanoma, were treated with interleukin-2. Drug toxicity consisted of capillary leakage syndrome in one case and reversible renal impairment in another. One patient showed an objective response; transient subjective improvement was observed in all patients.

Basophilic leukemia is a rare disease accounting for less than 2% of all hematopoietic malignancies and little is known about the best therapeutical approach. We report a case of basophilic leukemia occurring as an accelerated phase of chronic myelogenic leukemia in a 50 year old man with a past history of uranium and thorium exposure. He was successfully treated with intensive chemotherapy and total body irradiation followed by autologous peripheral stem cell transplantation. Such an approach has never been reported in this disease. However, the benefit on survival could not be evaluated because of a fatal opportunistic infection. The cases of basophilic leukemia reported in the literature are discussed.