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autologous blood and marrow transplantation - Blog Science ...

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Ball et al. 31<br />

Overall Survival for Patients Transplanted in R1<br />

80<br />

Months Post ABMT<br />

Figure 6<br />

Since reinfused <strong>marrow</strong> may be contaminated with residual malignant cells after<br />

autoBMT, we have used ex vivo purging to eliminate residual neoplastic cells from<br />

the graft. Long-term survival for AML patients after autoBMT using various methods<br />

for removing occult leukemia cells has been reported. 12-18<br />

The benefit of mafosfamide<br />

purging for patients transplanted in first CR within 6 months of attaining CR has been<br />

reported. 16<br />

Chao et al. 9<br />

published phase II studies showing that patients who received<br />

purged bone <strong>marrow</strong> (4-hydroperoxycyclophosphamide [4HC] or etoposide or both)<br />

had an actuarial DFS of 57% compared with a DFS of 32% in patients who received<br />

unpurged bone <strong>marrow</strong>. Yeager et al. 13<br />

have reported favorable results similar to<br />

alloBMT with 4HC <strong>marrow</strong> purging in patients with AML who underwent autoBMT.<br />

Miller et al. 29<br />

recently demonstrated that 4HC-purged autoBMT reported to the<br />

Autologous Bone Marrow Transplantation Registry (ABMTR) had significantly<br />

better outcomes than unpurged autoBMT in both CR1 <strong>and</strong> CR2/3.<br />

Brenner et al., 30<br />

in a gene marking trial in AML autografting, demonstrated that<br />

<strong>autologous</strong> <strong>marrow</strong> harvested from leukemia patients in remission may harbor<br />

malignant cells capable of contributing to relapse. This evidence suggests that<br />

effective <strong>marrow</strong> purging may be essential for improving the outcome of autoBMT<br />

for AML.<br />

160

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