Autologous Bone Marrow Transplantation - Blog Science Connections

A Study Design to Determine the Role of
Transplantation in Acute Leukemia
KarelA.
Dicke, Sundar Jagannath, Leonard J. Horwitz,
Gary Spitzer, and Kenneth McCredie
Autologous bone marrow transplantation (ABMT) in a patient with acute
leukemia entails the possible infusion of leukemic cells into the recipient. The
role of these infused leukemic cells in the recurrence of leukemia after ABMT
plus high-dose cytoreductive treatments is not yet clear.
ABMT in relapsing patients does not result in long-term disease-free
survivals (DFS) (1 ), whereas patients treated with allogeneic transplantation
or syngeneic transplants achieve a 20% DFS rate (2,3)- On one hand,
evidence suggests that in a certain percentage of patients the posttransplantation
leukemia recurrence originated from the infused leukemic
cells. On the other hand, data concerning ABMT during first remission do not
indicate that infused potentially leukemic cells have an active role in
recurrence.
We reported during the first ABMT symposium a low DFS rate in the
patient group treated with cyclophosphamide (Cytoxan), BCNC1 (carmustine),
and VP-16-213 (etoposide) (CBV) and unpurged marrow in a second
complete remission (CR2) or a subsequent remission (4). In this chapter we
report an update of our transplantation data in second and subsequent
remissions and describe a realistic study design to determine the effect of
purging on recurrence.
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