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86 Chapter 2: ALL<br />

ABMT/PBSCT in CR2 4 i<br />

Single ABMT in CR1<br />

Single PBSCT in CR1<br />

Double-PBSCT<br />

m<br />

GMALL-Protocol 05/93<br />

i<br />

i ii ill i i<br />

1992 1993 1994 1995 1996 1997 1998<br />

Figure 1. Recruitment of BCR-ABL+ patients from GMALL trials for <strong>autologous</strong> BMT or<br />

PBSCT (n=34).<br />

In vitro purging using immunomagnetic beads<br />

A total of 20 <strong>autologous</strong> bone <strong>marrow</strong> grafts were harvested from BCR-ABL +<br />

ALL patients in first (n=16) or second (n=4) morphologic CR. Purging was<br />

performed with anti-CD 19 +<br />

CD10 ±AB4 immunomagnetic beads (Dynabeads) <strong>and</strong><br />

two separation cycles using the Baxter MaxSep device as described in detail<br />

previously. 12<br />

' 14<br />

Autologous <strong>transplantation</strong><br />

Twenty-five patients in first («=21) or second («=4) complete remission<br />

received single <strong>autologous</strong> transplants after conditioning with fractionated total<br />

body irradiation (TBI) 14.4 Gy plus 120 mg/m 2<br />

cyclophosphamide ± 45 mg/m 2<br />

VP-16. Of the patients autografted in CR1, seven received two courses of induction<br />

chemotherapy according to the GMALL (05/93) protocol, <strong>and</strong> 14 received three or<br />

more courses (Fig. 2). From June 1996, patients were also eligible for a pilot<br />

double <strong>autologous</strong> transplant protocol as detailed in Fig. 3. 15<br />

RESULTS<br />

Residual BCR-ABL-positive cells in unpurged <strong>autologous</strong> grafts<br />

Before purging, residual BCR-ABL-positive cells were detected in 19 of 20 BM<br />

grafts at median 4 (range 0-6) log <strong>and</strong> in 21 of 28 évaluable PBSC grafts at median

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