Leukemia is a type of cancer that affects the blood and bone marrow, where blood cells are made. In leukemia, the bone marrow produces abnormal white blood cells that don't function properly and crowd out healthy blood cells.   

Bone marrow transplants may be necessary for leukemia patients in certain situations because they can:   

Leukemia treatment often involves chemotherapy to kill cancer cells. However, high doses of chemotherapy can severely damage the bone marrow, the very tissue responsible for producing healthy blood cells. A bone marrow transplant acts as a "rescue" for the damaged bone marrow. The transplanted healthy stem cells repopulate the bone marrow, allowing it to recover and resume producing healthy blood cells.

Chemotherapy is a common treatment for leukemia, but high doses can damage the bone marrow. A bone marrow transplant can replace the damaged bone marrow, allowing for higher doses of chemotherapy that may be more effective at killing leukemia cells. The transplanted bone marrow can also help boost the patient's immune system, which can help fight off the leukemia and other infections.   

Acute Myeloid Leukemia (AML): AML often requires intensive treatment, and a bone marrow transplant may be considered in first remission (no detectable signs of cancer) to prevent relapse. Chronic Myeloid Leukemia (CML): While medications like tyrosine kinase inhibitors (TKIs) are highly effective in treating CML, a transplant may be an option for patients who are not responding to TKIs, have severe side effects, or are considering a potential cure.

In some cases, the transplanted immune cells from a donor (in an allogeneic transplant) can recognize and attack any remaining leukemia cells in the recipient's body. This is known as the "graft-versus-leukemia" effect.

Bone marrow transplants are complex procedures with significant risks. They are not suitable for all leukemia patients. The decision to pursue a bone marrow transplant is made on an individual basis, considering factors like type and stage of leukemia, patient's age and overall health, treatment response to chemotherapy and other therapies, and availability of a suitable donor. 

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