autologous blood and marrow transplantation - Blog Science ...

Sierra et al.
No adverse factors (n= 14), 64%
—i 1 H—i 1—w-
-1
> 1 adverse factor (n=19), 21%
20 40 60 80 100 120
Months
Figure 8
Preliminary results in very high-risk leukemia, such as Ph +
ALL in CR1, appear
encouraging. 12
TRM occurred in approximately 10% of our patients. BM purging did not affect
hematologic recovery or increased mortality. Although no overall improvement
was noted with the use of PBSC, early TRM was not observed in this group. The
only fatal episode after PBSCT was sepsis >1 year after transplant, a very
uncommon event after autografts. It seems evident that to optimize autoSCT, for
patients with acute leukemia TRM should approach zero.
Relapse is the main cause for failure after autoSCT. The lower relapse rate
observed after P-autoBMT when compared with Unp-autoBMT could in part be
due to a beneficial effect of purging. Another possibility is that the Unp-autoBMT
group were selected for unfavorable prognostic patients. A minimum number of
cells was required for ex vivo treatment. The worst CR marrow may be the least
cellular and therefore not purged. In addition, the interval between CR and SCT,
an established prognostic factor, was shorter in the Unp-autoBMT than in the PautoBMT
group. It is noteworthy that none of the seven recipients of autoPBSCT
in CR1 relapsed after the procedure, and there are no data supporting that they
were good-risk patients. In fact, all had at least one adverse prognostic feature. It
is obvious that these results need confirmation in large series with prolonged
follow-up. The possibility that PBSC products are in some instances less contaminated
by tumor cells than BM has been suggested by some authors and needs
further investigation. 13
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