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Autografting with cultured marrow in chronic myeloid leukemia: results of a
pilot study [see comments]
MJ Barnett, CJ Eaves, GL Phillips, RD Gascoyne, DE Hogge, DE Horsman, RK Humphries, HG Klingemann, PM Lansdorp and SH Nantel
Leukemia/Bone Marrow Transplantation Program of British Columbia, Terry Fox
Laboratory, Vancouver Hospital and Health Sciences Centre, BC, Canada.
Incubation of chronic myeloid leukemia (CML) marrow for 10 days in vitro
causes a marked and selective loss of very primitive Philadelphia
chromosome (Ph)+ as compared with Ph- progenitors. We have autografted 22
patients with CML (16 in first chronic phase [group 1] and 6 with more
advanced disease [group 2]) with marrow treated in this way to facilitate
restoration of Ph- hematopoiesis after intensive therapy. Hematologic
recovery to greater than 0.5 x 10(9)/L neutrophils occurred in 16 patients,
and to greater than 20 x 10(9)/L platelets in 15 of 21 evaluable patients
at a median of 29 and 48 days postautograft, respectively. Regenerating
marrow cells were 100% Ph- in 13 patients and 75% to 94% Ph- in 3. Between
4 and 36 months (median 12) postautograft, Ph+ cells became detectable in
all but 1 (who died in remission) of the 13 patients who achieved complete
cytogenetic remission. Four of 7 evaluable patients treated with low-dose
interferon alpha were returned to complete cytogenetic remission. Thirteen
group 1 patients (81%) are alive 1.0 to 5.7 years (median 2.6) after
autografting: 4 in complete cytogenetic remission, 2 in hematologic
remission, 6 in chronic phase, and 1 in myeloid blast phase. Three group 2
patients (50%) are alive at 2.6, 3.8, and 4.3 years after autografting: 1
in partial cytogenetic remission, 1 in chronic phase, and 1 in accelerated
phase. Thus, autografts of cultured marrow can result in prolonged
restoration of Ph- hematopoiesis for some patients with CML.
Volume 84,
Issue 3,
pp. 724-732,
08/01/1994
Copyright © 1994 by The American Society of Hematology
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