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Miller et al.<br />

Adjusted probability of LFS after<br />

4HC-purged or unpurged <strong>autologous</strong> bone <strong>marrow</strong> transplants for<br />

acute myelogenous leukemia, by remission state<br />

3<br />

Yew<br />

Figure 2. Adjusted disease-Free survival of295 patients reported to the ABMTR registry,<br />

stratified by remission status <strong>and</strong> purging.<br />

hospital stay <strong>and</strong> increased resource utilization. Many studies have shown that the<br />

use of mobilized peripheral <strong>blood</strong> stem cells (PBSC) speeds engraftment compared<br />

with bone <strong>marrow</strong> stem cells. 9-11<br />

Several investigators have studied the use of PBSC<br />

as a source of stem cell grafts in AML, <strong>and</strong> long-term disease-free survival data are<br />

being collected. One study suggested a higher relapse rate with unpurged PBSC<br />

compared with purged bone <strong>marrow</strong> stem cell in patients with AML, due to a higher<br />

relapse rate in the unpurged PBSC arm. 11<br />

Mobilized PBSC are also likely to be<br />

contaminated with leukemia cells, suggesting a benefit to purging. There are no<br />

published trials of the clinical use of purged PBSC in patients with AML. An in vitro<br />

study 12<br />

compared the efficacy of purging normal <strong>and</strong> leukemic progenitors from<br />

bone <strong>marrow</strong> or PBSC. The data indicated no difference in the in vitro efficacy of<br />

purging clonogenic leukemia or normal myeloid progenitors related to stem cell<br />

source. Our preliminary data support the notion that myeloid progenitor recovery is<br />

similar to 4HC-purged PBSC <strong>and</strong> bone <strong>marrow</strong>.<br />

The use of purged PBSC is attractive in that the delay in engraftment with<br />

purging may be partially overcome by the increased progenitor cells in the PBSC<br />

7

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