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Treatment recommendations for aplastic anemia are based on long-term survival data for recipients of syngeneic or allogeneic bone marrow transplants (BMT) and the more recent results of “immunosuppressive therapy” (1ST), which usually includes antihuman thymocyte globulin (ATG) or antihuman lymphoblast globulin (ALG). Patient age and availability of a suitable marrow donor limit the number of patients who are potential candidates for marrow grafting. Many centers will not recommend an allogeneic BMT for patients with aplasia who are over 40 years of age, although some extend the upper age limit to 50 years. Suitable marrow donors include identical twins, genotypically HLA-identical siblings, or phenotypically HLA-identical family members. Transplants using HLA-mismatched family members or phenotypically identical, unrelated donors are usually reserved for “salvage” therapy after failure of a nontransplant treatment regimen.

Marrow transplantation for the treatment of severe aplastic anemia has to be viewed in the context of alternate therapies for this disease. An earlier study of the International Aplastic Anemia Study Group showed that newly diagnosed patients with severe aplastic anemia treated by supportive therapy with or without androgens had a survival of only 20% at 5 years, with most patients dying within the first 6 months of diagnosis [1]. Most surviving patients had partial or complete spontaneous hematologic recoveries sufficient to live without the need for transfusions. These results were subsequently confirmed by the study group in another cohort of patients [2].

Patients with disseminated malignant lymphoma who have failed first line chemotherapy are unlikely to be cured with additional chemotherapy or radiotherapy delivered at conventional doses. Based on the success of high dose chemoradiotherapy and marrow transplantation as treatment for relapsed leukemia, a number of studies have been performed using a similar approach in patients with relapsed malignant lymphoma (1–14). This report details the initial Seattle experience with autologous marrow transplantation as treatment for patients with relapsed or resistant malignant lymphoma and compares this approach with our previously published experience using syngeneic and allogeneic transplantation in a similar group of patients (3–5).

We report here our experience with 110 consecutive cases of severe aplastic anemia (SAA) treated with marrow grafts from HLA-identical siblings (109 patients) or from an HLA-identical mother (one patient) after the recipient had been conditioned with high doses of cyclophosphamide (Cy) and/or total-body irradiation (TBI). Detailed descriptions on the courses of the first 73 of these patients have been given previously (20,21,23).

Chronic graft-versus-host disease (GVHD) and associated infections are major determinants of late morbidity and mortality in 25–50% of long-term survivors of allogeneic marrow transplantation [1]. With improving supportive care during transplant, broadening criteria for donor selection and expanding indications and numbers of centers for transplant, an increasing number of long-term survivors are reported [2–4]. For primary care hematologists and oncologists, recognizing and treating late complications is of increasing importance. The following reviews the pathogenesis, diagnosis, treatment and prognosis of chronic GVHD.

Marrow transplantation has become an important therapeutic modality in the management of patients with acute nonlymphoblastic (ANL) and acute lymphoblastic leukemia (ALL). However, the optimal time for intervention in a patient’s disease course with marrow transplantation is yet to be determined. The following will briefly review the current situation.