The significance of minimal residual disease in stem cell grafts and the role of purging: is it better to purge in vivo or in vitro?
Contamination of autologous graft by tumor, in addition to incomplete tumor eradication, can partly explain why relapse remains the commonest cause of treatment failure after autologous stem cell transplantation (ASCT) in patients with malignant hematologic disorders. Monitoring of minimal residual disease (MRD) is now recognized as an important diagnostic tool for assessment either of the response to treatments aimed at maximal cytoreduction and the individual risk of relapse. In order to improve cure rates, many strategies to achieve in vivo or in vitro reduction, if not eradication, of residual disease have been proposed. We discuss the significance of MRD and the role of purging in the ASCT setting, focusing on acute myeloid leukemia, chronic myeloid leukemia, multiple myeloma and follicular lymphoma.
Melillo
Lorella
L
Division of Hematology and Stem Cell Unit, IRCCS S. Giovanni Rotondo and Division of Hematology, Azienda Ospedaliera Universitaria San Martino, Genova, Italy. lorella_melillo@hotmail.com
Cascavilla
Nicola
N
Lerma
Enrica
E
Corsetti
Maria Teresa
MT
Carella
Angelo Michele
AM
D002458:Cell Fractionation / Q000379:methods; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D018365:Neoplasm, Residual; D012008:Recurrence; D033581:Stem Cell Transplantation / Q000379:methods; D014182:Transplantation, Autologous