Is the Basis of Cleaning Autologous Bone Marrow Transplants in Leukemia Strong Enough?
Bone marrow transplantation (BMT) from allogeneic donors following intensive chemotherapy and total body irradiation produces lasting remissions in a significant number of patients with acute lymphoblastic and myeloblastic leukemia (1–4). Autologous bone marrow transplantation (ABMT) in patients with acute leukemia may benefit from the same cytotoxic therapy. Its attractivity relates to the fact that each patient would have a donor, i.e. be his or her own donor, and that (in the absence of graft-versus-host disease) age restriction for transplantation is far less to be considered. On the other hand, ABMT is likely to involve a higher rate of leukemia relapse post transplantation. The first results of ABMT were obtained in end stage patients, and although they resulted in new remissions, these were usually of short duration (5). More recently several groups have started ABMT in patients with acute leukemia during their complete remission. This approach is foreseen to achieve a tumor cell killing due to: a) the pretransplant chemo- and radiotherapy; b) autologous bone marrow is probably contaminated with subclinical numbers of leukemic cells; the reinfusion of autologous bone marrow may result in a further decrease of tumor due to loss of cells in various tissues following intravenous administration (inappropriate seeding) (6–9); c) when purging methods are applied to the marrow graft, neoplastic cells may be successfully eliminated.
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