VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

stage. However, the clinical results obtained after reinfusion of these BSCs in CP
patients Ph-negative at 3,7 and 14 months after ABMT, support the view that,
even if it is not so absolute as it seems, at least a very good recovery of normal
BSCs has been obtained.
The proposed mechanism of the normal hemopoietic rebound during early
recovery phase following intensive conventional chemotherapy is difficult to be
explained. A possible mechanism could be that the most primitive pluripotent
stem cells are metabolically and mitotically quiescent and less sensitive to most
cytotoxic agents than the more mature progenitor cells. Acute depopulation of
the mature cells by intensive chemotherapy presumably sends signals which
stimulate the pluripotent stem cells to repopulate the committed and maturing
compartments (6). The combination of myeloblastolitic drugs such as Idarubicin,
intermediate-dose ARAC and VP-16, produce severe but reversible marrow hypoplasia
followed by vigorous hematological recovery which starts about two
weeks after the chemotherapy.
In conclusion, though further work is needed to evaluate the durability of
the results so far obtained and further refinements such as the use of synergistic
combinations of CSFs with myeloblative chemotherapy for BSC mobilization
still needs to be explored, we believe that this kind of approach may lead to mobilization
of a higher percentage of normal BSC and, therefore, to a more effective
autotransplant.
RESULTS OF IDARUBICIN-COINTAINING REGIMEN MOBILIZATION IN 20 PATIENTS
WITH CML
Patients 20
Median Total MNC 3.1 (range 1.3-7.6)
(108/Kg)
Median Total 0.6 (range 0-13.3)
CFU-GM harvested
(104/Kg)
Median CD34VCD33 /Dr 0.4 (range 0.1-1.13)
(106/Kg)
REFERENCES.
1. Goldman J.M., Apperley JF, Jones L. et al.: Bone marrow transplantation for patients
with chronic myeloid leukemia. N. Engl. J.Med. 1986; 314:202-207.
2. Thomas ED, Clift RA, Fefer A et al.: Marrow transplantation for the treatment of
chronic myelogenous leukemia. Ann Inter. Med. 1986; 104:155-163.
3. Talpaz M, Kantarijian H, Kurzrock et al.: Interferon-alpha produces sustained
cytogenetic responses in chronic myelogenous leukemia. Ann. Intern. Med. 1991;
114:532-538.
4. Barnett MJ, Eaves CJ, Phillips GL et al.: Successful autografting in chronic myeloid
leukemia after maintenance of marrow in culture. Bone Marrow Transplantation
1989;4:345-351.
5. Reiffers J, Trouette R, Marit G et al.: Autologous Blood stem cell transplantation for
chronic granulocytic leukaemia in transformation: A report of 47 cases. Br. J.
Haematol. 1991; 77:339-345.
6. Carella AM, Gaozza E, Raffo MR et al.: Therapy of acute phase chronic myelogenous
leukemia with intensive chemotherapy, blood cell autograft and cyclosporine A.
Leukemia 1991; 5:517-521.
214 SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION