Autologous marrow transplantation for patients with chronic myelogenous leukemia (CML) in blast crisis

Abstract

Even patients with chronic myelogenous leukemia (CML) in blast crisis were treated with chemotherapy, followed by infusion of autologous bone marrow that had been collected during the chronic phase of the disease and cryopreserved at -198 degrees C. The mean age of the nine females and two males in this study was 34 years with an average duration of the chronic phase of the disease of 5.5 years. Seven out of the 11 patients had a splenectomy prior to intensive chemotherapy. The median survival of the first four patients who received 6-thioguanine, cytosine arabinoside, daunorubicin (TAD) chemotherapy was 2.6 weeks and no patient reachieved the chronic phase of CML. The second group of seven patients received more intensive chemotherapy (MAdHAT), which included melphalan 30 mg/m2 days 1, 2, and 3; Adriamycin 50 mg/m2 intravenously (iv) day 1, hydroxyurea 1500 mg/m2 by mouth for 5-7 days, cytosine arabinoside 100 mg/m2 continuous infusion for 5-7 days, and VM-26 100 mg/m2 iv on day 3. Six out of these seven patients reachieved chronic phase CML after bone marrow reinfusion. The median survival was 29.9 weeks for all patients and 33 weeks for the six patients who reachieved chronic phase CML. All patients subsequently died of recurrent blast crisis. There was no correlation between the time of bone marrow storage and the duration of subsequent chronic phase CML. These studies have shown that autologous bone marrow transplantation after high-dose chemotherapy can result in bone marrow engraftment with reestablishment of chronic phase CML, and prolongation of survival.

Factors affecting duration of survival after onset of blastic transformation of chronic myeloid leukemia

“…15,16 In 1996, we reported the use of a reduced intensity regimen using busulfan alone for BLOOD, 1 APRIL 2002 ⅐ VOLUME 99, NUMBER 7 For personal use only. on April 2, 2019. by guest www.bloodjournal.org From autografts in patients in BT, which resulted in restoration of chronic phase in 5 of 9 patients, with relatively little toxicity.…”

Treatment of chronic myelogenous leukemia with autologous bone marrow transplantation followed by roquinimex

“…[16][17][18][19] The fact that this has not resulted in major improvement compared with the use of unmanipulated grafts is not completely surprising. The preponderance of the data now suggest that the immunologic mechanisms inherent in graft-versus-leukemia are primarily responsible (11) 96 (10) 33 (3) 89 (6) 152 (7) 460 (13) CD56 ϩ NK 52 (3) 44 (13) 81 (8) 32 (3) 95 (6) 129 (6) 402 (8) CD57 ϩ NK 20 (1) 12 (4) 26 (3) 10 (1) 19 (1) 48 (3) 309 (4) all CD57 ϩ 124 (11) 72 (19) 318 (28) 273 (24) 340 (23) 510 (25) 997 (26) CD20 ϩ B…”

“…2,5,7,8 Most of the early studies attempted to treat patients with CML in accelerated phase or frank blast crisis using prior cryopreserved cells obtained during the chronic phase. 7,[9][10][11][12][13][14] In these reports either unmanipulated bone marrow or peripheral blood stem cells, or both, were used. Unmanipulated ABMT has also been used, with some success for patients in first chronic phase.…”

Chemotherapy and autografting for chronic granulocytic leukaemia in transformation: probable prolongation of survival for some patients

“…The availability of cryopreserved autologous stem cells ensures that patients in BT can be treated with intensive combinations of cytotoxic drugs, with or without TBI, with the virtual certainty that haemopoiesis can subsequently be re-established. We and others have exploited this approach in the management of CGL in BT (Goldman et al, 1979, 1981a: Korbling et al, 1981: Reiffers et al, 1983: Gorin et al, 1982: Thomas et al, 1984Phillips & Herzig, 1984). In almost all cases patients are restored to second CP which lasts typically between 8 and 40 weeks.…”