Cost Effectiveness of Bone Marrow Transplantation

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Abstract
The article by Welch and Larson (Sept. 21 issue)* on the cost effectiveness of bone marrow transplantation in leukemia is a useful analysis of the present situation. In discussing the implications for the future, however, the authors ignore one important point — the continuing improvements in cancer chemotherapy. Although the technique of whole-body irradiation followed by bone marrow transplantation will no doubt be further refined and improved, obliterating systemic disease by this relatively crude method damages normal cells, and its ultimate potential must be limited. On the other hand, cancer chemotherapy has steadily improved from the early era of fortuitous discovery to the era of rational empiricism and may now be poised on the threshold of selective molecular intervention. Certainly, there is no going back.