AUTOLOGOUS BONE MARROW TRANSPLANTATION IN PATIENTS WITH ADULT ACUTE LEUKEMIA IN RELAPSE

Abstract

Nine patients with adult acute leukemia were treated in relapse with piperazinedione plus supralethal total body irradiation in conjunction with autologous marrow infusion. Bone marrow cells were collected and stored in first remission. Storage time varied from 3 to 23 months. Before storage, marrow cells were separated using density albumin gradients in order to reduce the number of leukemic cells in the graft. Three patients died before day 14 after transplantation because of complications already present at the time of transplantation. In six patients, hemopoietic recovery started to occur within 14 days after transplantation. In four patients leukemia-free periods were obtained, lasting 60+ days. The three patients with the longest leukemia-free period after transplantation (range 75 to 220+ days) are reported in more detail. One patient is still alive without evidence of leukemia, with full hematological recovery 220+ days after transplantation. Recently progress has been made in increasing rates of remission in adult acute leukemia using combination chemotherapy, but only 25 to 30% of the patients survive for 2 years or longer (1). Allogeneic bone marrow transplantation, using HLA-identical mixed leukocyte culture-negative related donors in combination with chemotherapy and total body irradiation (TBI), has been used as therapy in relapsed leukemia patients. Allogeneic marrow transplantation, however, is limited to only 25% of relapsed leukemia patients because of the low frequency of compatible marrow donors. Autologous bone marrow cells collected in remission may offer an alternative to allogeneic marrow cells for transplantation in relapse. In this paper we report the overall results of nine patients, and more specifically the data of three patients with adult acute leukemia who were treated at the time of relapse with high-dose chemotherapy and TBI, followed by autologous marrow infusion. The marrow cells to be used for transplantation were collected and subsequently stored in first or second remission. The patients were grafted in relapse when chemotherapy alone failed to induce a remission. In order to reduce the number of transplanted leukemia cells in the graft, the bone marrow cell suspensions were fractionated using discontinuous albumin density gradients before storage (2).