Klin Onkol 2000; 13(2): 42-47.
Summary: Chronic myelogenous leukemia (CML) is a lethal hematopoietic malignancy, which progresses from a chronic phase to a fatal blast crisis. Although interferon - alpha (INF), the best agent from the first-line conventional therapy, can prolong the chronic phase, this therapy is not curative. Allogeneic bone marrow transplantation (allo-BMT) is the only option with curative potential at present. Unfortunately, allo-BMT has its limitations and more than half of patients may not be eligible for allo-BMT. Autologous BMT (auto-BMT), which is tested as a treatment option for patients with CML, is reviewed in this article. The first generation of clinical trials has shown that auto-BMT is a feasible strategy with encouraging results in the first multicentric analysis. A number of „in vivo“ and „ex vivo“ purging techniques were evaluated to reduce high tumor contamination of autologous graft in CML patients. Despite the fact that during the last few years an increasing number of patients suffering from CML have undergone autologous BMT in the world, the exact role of autologous BMT in CML has not yet been established. This question has to be addressed by undergoing the prospective randomized trials which would compare allo-BMT, auto-BMT and standard treatment in patients with CML. Lack of graft-versus tumor effect is one of the possible factors responsible for the higher relapse rate seen after auto-BMT than after allo-BMT. Thus, induction of GVL effect in the autologous setting and combination of auto-BMT with intensive immunotherapy is a promising approach.
