autologous blood and marrow transplantation - Blog Science ...

Autografring for Chronic Myeloid Leukemia
in Chronic Phase:
EBMT Retrospective Analysis and Proposals
for a Prospective Study
J.M. Goldman, J. Reiffers, J.E Apperley, AM. Carella
ICSM Haematology Department, Hammersmith Hospital, London, U.K.;
Université Victor Segalen, Bordeaux, France; and
Ospedale San Martino, Genoa, Italy
In the late 1970s, selected patients with CML in transformation were treated by
high-dose chemotherapy and autografted with marrow and later with blood-derived
stem cells. The majority of patients were restored to chronic phase hematopoiesis,
but there was no convincing evidence that their survival was prolonged. In the early
1980s, various groups performed autografts for patients in chronic phase using
unmanipulated marrow or blood stem cells. The collected data for EBMT collaborating
centers has been analyzed on a number of occasions. The toxicity of the
procedure was low. Patients who achieved some degree of Ph-negativity survived
longer than those who recovered exclusively Ph-positive hematopoiesis. Some
patients achieved durable Ph-negativity. Again, there was no formal proof that
survival was prolonged in comparison with conventional treatment with cytotoxic
drugs or interferon-alpha. Against this background, the EBMT has designed and
activated a prospective study whereby patients at diagnosis will be randomly
allocated to receive either treatment with interferon-alpha (± cytarabine) or an
autograft with stem cells collected at diagnosis or after mobilization with cytotoxic
drugs and G-CSF. This study addresses the issue of whether the addition of an
autograft procedure early after diagnosis contributes to prolongation of survival for
patients not eligible for an allograft procedure.
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