autologous blood and marrow transplantation - Blog Science ...

64 Chapter 2: ALL
leukemia) appears to be present in ALL, although it is less pronounced than in
CML or AML.
Age is another significant prognostic factor for survival after alloBMT. In
patients >40 years old, TRM (37 vs. 28%) as well as relapse incidence (38 vs. 29%)
are higher compared with younger patients, 5
leading to a less favorable LFS.
RESULTS OF AUTOLOGOUS BMT IN CR1
The LFS after autoBMT in CR1 of approximately 42% (15-75%) is somewhat
inferior compared to alloBMT (Table 1). Several trials comparing alio- and
autoBMT demonstrated an advantage of alloBMT in terms of LFS and RI, whereas
TRM after autoBMT was clearly lower. 67
AutoBMT can be employed in elderly patients up to approximately 65 years of
age due to its low TRM (2-8%). The major disadvantage of autoBMT is the high RI
(51%) probably caused to a lesser extent by the reinfusion of leukemic blasts but
more by the lack of GVL effects. Purging of the marrow graft with monoclonal
antibodies, chemotherapeutic drugs or immunomagnetic beads is of interest since it
may reduce the leukemia cell burden. Thus, purging with immunomagnetic beads can
reduce tumor load by 2 log either for BM or for PB grafts in ALL. 8
However, no
comparative studies with purged and unpurged autoBMT have been reported to date.
In addition to purging, the administration of maintenance treatment after
autoBMT may contribute to a reduction of RI. A favorable LFS of 53% has been
achieved in a single-center trial with autoBMT or PBSCT in 50 adult ALL patients
in first CR followed by a 2-year maintenance treatment with 6-mercaptopurine and
methotrexate. 9
Other options for maintenance therapy after autoBMT are biological
response modifiers such as interferon-a or interleukin-2. The reported results,
however, are not conclusive.
AutoBMT is a reasonable treatment option for a substantial number of Ph +
patients >50 years old without a sibling donor, for whom a MUD transplant is not
considered. Thus, a large proportion of Ph +
ALL patients remain candidates for
autologous transplants. The LFS in 37 patients after autoBMT from several small
series was 37% (Table 1).
RESULTS OF PERIPHERAL BLOOD STEM CELL TRANSPLANTATION
(PBSCT) IN CRI
Transplantation of PBSC instead of bone marrow is increasingly employed in
adult ALL since TRM may be reduced due to faster bone marrow recovery. Even
more importantly, experience in Ph +
ALL shows that the tumor load is lower in
PBSC grafts compared to bone marrow. Since in heavily pretreated ALL patients,
it may be difficult to collect a sufficient number of stem cells from the peripheral