autologous blood and marrow transplantation - Blog Science ...

Hehlmann et al. 119
Table 4. Correlation of intensity of treatment, reduction of tumor load and survival
• Survival of relapses after allo-BMT (Zhang et al., 1997 22
)
• Interferon-a intensified by Ara C (Guilhot et al., 1997 23
; Tura, 1998 24
)
• High dose CHT and autografting (McGlave et al., 1994 18
; Carella et al., 1996 25
;
Goldman et al., 1996 26
)
• Intensive chemotherapy, no maintenance (Cunningham et al., 1979 27
; Sharp et al, 1979 28
;
Kantarjian et al., 1987 21
)
« High-dose Hydroxyurea (Kolitz et al., 1992 29
)
High-dose chemotherapy followed by autografting (CML Study III A)
This approach represents a further intensification of treatment. It makes use of
2 5 2 6
the observation that normal stem cells are present in CML, '
particularly in the
early phase of the disease, and can be mobilized by chemotherapy and growth
factors. 17
First observations of normal progenitor cells in CML date back to the
early 1970s and 1980s when cytogenetic mosaicism was observed after busulfan
treatment and Philadelphia chromosome (Ph)-negative progenitor cells were
detected in long-term culture (Table 5).
Favorable survival results after autografting have been observed in several
studies (Table 6). The largest series is that by McGlave and coworkers, 18
which
was updated in 1997. The update continues to show a 5-year survival of patients
treated in chronic phase of more than 50%. 27
The more general feasibility of high-
Genetic
R
yes
Related donor
available? MUD
available?
Stratification:
Suitable for
transplantation
consent?
German CML Study
HU/IFN 1
12 months
yes
ifPh*