Bone Marrow Transplantation at Princess Margaret Hospital, University of Toronto

Abstract

It has now been more than a quarter century since the first transplant was done at PMH and the longest survivor is out 24 years. Current indications include acute myeloid and lymphocytic leukemias, chronic myeloid leukemia, aplastic anemia, myelodysplasia and myelofibrosis, lymphomas and chronic lymphocytic leukemia, hemoglobinopathies, and other rare hematological disorders. Patient number have been increasing yearly as indications change and the upper age limit slowly pushes upward. Transplant from related donors are being supplemented by the use of unrelated donors and more recently by the use of haploidentical family members. Results with the later two donors have yet to reach the success of transplants from phenotypically identical relatives. Outcomes have improved over the years because of the realization that early transplant is preferable and due to better supportive care-graft versus host diseases and cytomegalovirus therapy as examples. Future improvements and cost savings may results from the development of peripheral blood progenitor cell technology and marrow element growth hormone developments, and identification of which HLA differences are significant in predicting outcomes.