Autologous Bone Marrow Transplantation - Blog Science Connections

Autologous Transplantation of Unpurged Bone
Marrow During First Remission of
Acute Myeloid Leukemia
Alan K. Burnett, Stephen Mackinnon, and Ann Morrison
In recent years, we and others have been investigating the use of ablative
chemoradiotherapy or chemotherapy alone with autologous marrow infusion
as an alternative strategy of consolidating the first remission in patients with
acute myeloid leukemia (AML). We are encouraged by the prospect of using
autologous bone marrow transplantation (ABMT) because of the 70-90% of
patients remaining leukemia-free after allogeneic bone marrow transplantation.
We recognize that potentially important components are involved in the
allograft that would not be present in the autologous situation. One in particular
is the loss of the postulated graft-versus-leukemia effect. Such an effect has
been demonstrated experimentally, usually in lymphoid leukemia models (1),
and a statistical prediction of a higher prospect of remaining leukemia-free
along with a higher grade of graft-versus-host disease (GVHD) was shown by the
Seattle group (2) in patients with relapsed leukemias and those with acute
lymphoid leukemia in remission but not in patients with AML in remission. This
association may be difficult to demonstrate, however, when the overall relapse
rate is as low as 20%. Some evidence suggests that chronic GVHD may be
associated with a lower relapse rate (3). Perhaps the more important evidence
to indicate an allogeneic effect is the increased relapse rate (50%) observed in
23