Autologous Bone Marrow Transplantation - Blog Science Connections

202 Autografting in Chronic Granulocytic Leukemia
metaphases. After they received transplants of in vivo purged marrow
containing, respectively, 1 and 2.9 x 10 4 thawed CFCI-GM cells/kg, engraftment
was very prompt in both cases. After transplantation, one of the patients had a
mixture of Ph 1 -positive and Ph 1 -negative cells for 4 months until the typical
features of the chronic phase returned. After ABMT, the percentage of Ph 1 -
negative marrow cells found in this patient never exceeded substantially the
percentage of Ph 1 -negative cells transplanted. The other patient achieved
"clinical" remission after transplantation and is still in continuous clinical
remission 18 months after transplantation.
Such a Ph 1 -negative status has previously been reported in patients with
CGL in transformation undergoing autologous transplantation of marrow or
blood cells (see review, 13). The latter case confirms the proliferative advantage
of Ph 1 -negative precursors transplanted to the patient, an advantage that may
be the result of selective cryoinjury of Ph 1
-positive progenitors (14). The results
observed in our patient differ from those of other reports in two remarkable
aspects: the number of Ph 1 -positive cells present after transplantation was very
low and the duration of clinical remission was very long, suggesting that the
preclinical phase of CGL was restored. Moreover, autologous transplantation
may have prolonged the chronic phase. This encouraging result was obtained
in the one patient who received a transplant only 16 months after diagnosis of
CGL (versus 18, 45, and 91 months for the other patients), so that ABMT, if
used, should be considered early in the course of CGL ( 15).
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