PurposeBone marrow transplantation is an effective treatment for leukemia. Cures are possible in 20–80% of transplant recipients depending on the stage of leukemia at the time of transplant. The antileukemia efficacy of transplants result from high-dose chemotherapy and/or radiation given pretransplant and from immune-mediated effects of the graft.ResultsSuccess of the procedure is limited by transplant-related complications, including graft rejection, graft-vs.-host disease and interstitial pneumonia. Five-year leukemia-free survival ranges from ±25% for children trans-planted with advanced leukemia, to >60% in those transplanted in first remission of acute leukemia or first chronic phase of chronic myeloid leukemia.ConclusionsCandidates for transplant include children failing conventional therapy and, possibly, those with early leukemia characterized by features predicting a poor response to conventional therapy.