Autologous Bone Marrow Transplantation - Blog Science Connections

52 Panel Discussion: Session IA
DR. GORIN: Tony (Dr. Goldstone), the slide you showed emphasizes the
advantage of a double autograft. When we wrote the European study, half of the
patients having double autografts came from your institution, and we cautioned
against some kind of premature conclusion because of a possible selection
bias. Do you think double autografting is indeed beneficial or not?
DR. A. GOLDSTONE: It is clear that the small group of AML patients in first
remission, who managed to get through two autografts, is doing well. Those
were patients who were fit, went in remission early, had cellular marrows with
good counts, recovered soon after transplantation and, therefore, tended to
enter the group that became eligible for a second graft.
DR. D. BCICKNER: I just have one comment on study design. 1 think that if
you are going to do these studies, you ought to store the marrow on everybody
in first remission and randomize them to get their transplant either in second
remission or at time of relapse. That is the only way you are going to be able to
get the salvage rate plus an accurate reflection of the chemotherapy cures. We
can salvage 30% of patients with allografts in first relapse. We ought to be able to
do the same with autografts.
DR. LOWENBERG: We have come to the end of this session. It is clear that
what we need is more comparative studies. The various studies presented to us
today have at least indicated that there are several options for improvement of
autografting. We feel that, even though the results are encouraging, we
continue to deal with a high relapse rate. We need to address the question of
more effective conditioning regimens, certainly in future trials. It should
probably also be done in comparative settings. And, of course, the question of
purging, which, at present, is very important, is still an open issue. Thankyou all
for your contributions.