In less than a decade since the Seattle team achieved a successful bone marrow transplantation,1 this procedure has become an acceptable treatment for leukemia and a preferred treatment for severe aplastic anemia.2 However, the success of this therapy is lessened by complicating infections and graft-vs-host reactions, with attendant graft rejection and mortality. Even though the donor is a family member with identical human leukocyte antigen, the risk of graft rejection hangs over the patient like the sword of Damocles.
To reduce the risk of graft rejection, a conditioning immunosuppressive regimen is scrupulously followed. This usually entails using total-body irradiation, methotrexate for prevention of graft-vs-host reaction, and corticosteroids and antithymocyte globulin when this reaction develops. Despite such regimens the incidence of graft-vs-host disease remains high. Thomas and associates3 reported the occurrence of this complication in 12 of 19 marrow transplant patients with acute myelogenous leukemia, five of whom
Samuel Vaisrub. Minimizing Complications of Bone Marrow Transplantation. JAMA. 1980;243(23):2427–2428. doi:10.1001/jama.1980.03300490045029