Autografting with cultured marrow in chronic myeloid leukemia : results of a pilot study

• Published in: Blood 1994-08, Vol.84 (3), p.724-732
• Main Authors: BARNETT, M. J, EAVES, C. J, REECE, D. E, SHEPHERD, J. D, SPINELLI, J. J, SUTHERLAND, H. J, EAVES, A. C, PHILLIPS, G. L, GASCOYNE, R. D, HOGGE, D. E, HORSMAN, D. E, HUMPHRIES, R. K, KLINGEMANN, H. G, LANSDORP, P. M, NANTEL, S. H
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone Marrow Transplantation - methods; Bone marrow, stem cells transplantation. Graft versus host reaction; Cells, Cultured; Female; Graft Survival; Hematopoiesis; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - surgery; Leukocyte Count; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Neutrophils; Pilot Projects; Survival Analysis; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Autologous
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.v84.3.724.724

Incubation of chronic myeloid leukemia (CML) marrow for 10 days in vitro causes a marked and selective loss of very primitive Philadelphia chromosome (Ph)+ as compared with Ph- progenitors. We have autografted 22 patients with CML (16 in first chronic phase [group 1] and 6 with more advanced disease [group 2]) with marrow treated in this way to facilitate restoration of Ph- hematopoiesis after intensive therapy. Hematologic recovery to greater than 0.5 x 10(9)/L neutrophils occurred in 16 patients, and to greater than 20 x 10(9)/L platelets in 15 of 21 evaluable patients at a median of 29 and 48 days postautograft, respectively. Regenerating marrow cells were 100% Ph- in 13 patients and 75% to 94% Ph- in 3. Between 4 and 36 months (median 12) postautograft, Ph+ cells became detectable in all but 1 (who died in remission) of the 13 patients who achieved complete cytogenetic remission. Four of 7 evaluable patients treated with low-dose interferon alpha were returned to complete cytogenetic remission. Thirteen group 1 patients (81%) are alive 1.0 to 5.7 years (median 2.6) after autografting: 4 in complete cytogenetic remission, 2 in hematologic remission, 6 in chronic phase, and 1 in myeloid blast phase. Three group 2 patients (50%) are alive at 2.6, 3.8, and 4.3 years after autografting: 1 in partial cytogenetic remission, 1 in chronic phase, and 1 in accelerated phase. Thus, autografts of cultured marrow can result in prolonged restoration of Ph- hematopoiesis for some patients with CML.