Current BMT role

The role of BMT depends on the underlying disease being treated. It is the major component of therapy in disorders with defective or deficient haematopoietic progenitor cells (HPCs) such as aplastic anaemia or inherited immunodeficiency diseases. It is also often the only possible therapy for patients with a variety of diseases caused by defect of cells derived from the bone marrow, such as a variety of storage disorders.

BMT is one of several possible pathways in the management of a variety of malignancies of the blood, or haematological malignancies, such as leukaemia and lymphoma. It is used where high dose chemotherapy or radiotherapy can eradicate malignant cells (along with normal HPCs which must therefore be replaced), or in the situation where donated haematopoietic cells can destroy the recipient's malignancy (graft versus malignancy effect).

For haematological malignancies BMT is rarely the initial therapy, but follows preceding therapy which brings the patient to an optimal state for the transplant to be successful. This generally means having the underlying malignancy in remission and the patient in good medical condition. In general clinical practice and in many clinical trials there is a high attrition rate from the time at which patients present with the initial malignancy until the time when patients undergo transplantation. The overall success is therefore dependent heavily on the proportion of patients who progress successfully from the initial therapy to the beginning of the actual transplant procedure. The management of such patients, prior to transplant, requires a range of resources and high levels of skill from the clinicians. Therefore, a highly effective transplant program requires a comprehensive approach from pre-transplant to follow-up care. It is critical that BMT centres work closely with all teams managing haematological malignancy and other marrow disorders.