Autografting in Chronic Myeloid Leukemia
Autografting was first attempted for patients with chronic myeloid leukemia (CML) in transformation in order to restore a second chronic phase (CP). The principal rationale for autografting in CP resides on the reduction of the tumor burden and the number of leukemic cells at risk of developing blastic transformation, and the possibility of eradicating already mutated cells. In a European Group for Blood and Marrow Transplantation (EBMT) survey, patients with CML in CP, undergoing autologous stem cell transplantation (SCT) for the first time, had an overall survival of 65% at 5 years from transplant with more than 50% of all patients remaining in CP. The main point made by this retrospective study was that in patients refractory to interferon alpha (IFN), 70% achieved a cytogenetic response post autografting, which was complete or major in 31%. Since the advent of imatinib, autografting in CML has experienced a substantial decline. Theoretically, there are several possible ways of using autologous SCT in combination with imatinib: (1) to reverse resistance to imatinib; (2) to eliminate a Ph-positive clone bearing a BCR-ABL kinase domain mutation; and (3) to reduce the level of residual disease after a cytogenetic response to imatinib in patients in whom Ph-negative cells had been harvested.
KeywordsChronic Myeloid Leukemia Chronic Myelogenous Leukemia Autologous Stem Cell Transplantation Peripheral Blood Stem Cell Chronic Myeloid Leukemia Patient
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- Apperley JF, Boque C, Carella A et al (2004) Autografting in chronic myeloid leukaemia: a meta-analysis of six randomised trials. Bone Marrow Transplant 33:S28Google Scholar
- Bouzgarrou R, Reiffers J (1991) Cellules souches circulantes et LMC: modalités de prélèvement, congélation, décongélation, reconstitution hématologique après greffe. Presented at the Réunion du groupe Hémobiologie du FAG, 22 Octobre 1991Google Scholar
- Carella AM, Lerma E, Corsetti MT et al (1999) Autografting with Philadelphia chromosome negative mobilized hematopoietic progenitor cells in chronic myelogenous leukemia. Blood 83:1534–1539Google Scholar
- Carlo-Stella C, Regazzi E, Andrizzi C et al (1997) Use of granulocyte-macrophage colony-stimulating factor (GM-CSF) in combination with hydroxyurea as post-transplant therapy in chronic myelogenous leukemia patients autografted with unmanipulated hematopoietic cells. Haematologica 82(3):291–296PubMedGoogle Scholar
- Jazwieck B, Mahon FX, Pigneux A et al (1995) 5-Fluorouracil-resistant CD34+ cell population from peripheral blood of chronic myelogenous leukemia patients contains BCR-ABL negative progenitor cells. Exp Hematol 23:1509–1514Google Scholar
- Meloni G, De Fabritiis P, Alimena F et al (1990) Autologous bone marrow transplantation or peripheral blood stem cell transplantation for patients with chronic myelogenous leukaemia in chronic phase. Bone Marrow Transplant 4(Suppl. 4):92–94Google Scholar
- Reiffers J, Goldman J, Meloni G, Cahn JY, Gratwohl A on behalf of the Chronic Leukaemia Working Party of the EBMT (1994) Autologous stem cell transplantation in chronic myelogenous leukaemia: a retrospective analysis of the European Group for Bone Marrow Transplant. Bone Marrow Transplant 14:407–410PubMedGoogle Scholar
- Reiffers J, Goldman JM, Meloni G, Cahn JY, Apperley J (1996b) Autologous stem cell transplantation (Auto-SCT) for chronic myeloid leukemia (CML) in chronic phase: a report of the European Blood and Marrow Transplant (EBMT) Group. 22nd Annual Meeting of the EBMT, Vienna (Austria) Bone Marrow Transplant 17(Suppl.1), S3, abstract no. 56Google Scholar
- Silver RT, Woolf SH, Helhmann R et al (1999) An evidence-based analysis of the effect of busulfan, hydroxyurea, interferon, and allogeneic bone marrow transplantation in treating the chronic phase of chronic myeloid leukemia: developed for the American Society of Hematology. Blood 94:1517–1536PubMedGoogle Scholar
- The Italian Cooperative Study Group on Chronic Myeloid Leukaemia (1993) Karyotype conversion by interferon as preparative treatment for autologous BMT in Ph positive CML. Leuk Lymphoma 11(Suppl 1):277–280Google Scholar