title: Autografting with cultured marrow in chronic myeloid leukemia: results of a pilot study.
abstract: 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.
authors.affiliation: Leukemia/Bone Marrow Transplantation Program of British Columbia, Terry Fox Laboratory, Vancouver Hospital and Health Sciences Centre, BC, Canada.
authors.forename: M J
authors.initials: MJ
authors.lastname: Barnett
authors.forename: C J
authors.initials: CJ
authors.lastname: Eaves
authors.forename: G L
authors.initials: GL
authors.lastname: Phillips
authors.forename: R D
authors.initials: RD
authors.lastname: Gascoyne
authors.forename: D E
authors.initials: DE
authors.lastname: Hogge
authors.forename: D E
authors.initials: DE
authors.lastname: Horsman
authors.forename: R K
authors.initials: RK
authors.lastname: Humphries
authors.forename: H G
authors.initials: HG
authors.lastname: Klingemann
authors.forename: P M
authors.initials: PM
authors.lastname: Lansdorp
authors.forename: S H
authors.initials: SH
authors.lastname: Nantel
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D002478:Cells, Cultured; D005260:Female; D006085:Graft Survival; D006410:Hematopoiesis; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000601:surgery*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009504:Neutrophils; D010865:Pilot Projects; D016019:Survival Analysis; D013997:Time Factors; D014182:Transplantation, Autologous