Autografting for chronic myelogenous leukemia

Two thirds of patients with chronic myelogenous leukemia do not have suitable donors for allogeneic transplantation. As for other leukemias, autografting may potentially be curative, because normal Ph- hematopoietic stem cells persist in the marrow and blood of patients with chronic myelogenous leukemia. Several studies indicate that use of unpurged autologous blood or marrow grafts may extend survival for patients undergoing transplantation in chronic phase. Ex vivo or in vivo purging of chronic myelogenous leukemia marrow or blood prior to autografting may result in increased cytogenetic remissions after transplantation in those patients in whom the Ph+ clone can be eliminated. However, when the Ph+ clone cannot be eliminated, use of purged rather than unpurged autografts provides no advantage and may be associated with increased graft failure. Although sustained cytogenetic remissions have not been observed, autografting may result in a plateau in the survival curve not observed with conventional chemotherapy. Efforts are currently directed toward developing improved methods of purging as well as posttransplantation treatments directed against leukemic cells persisting after myeloablative therapy.