SPONTANEOUS GRAFT-VERSUS-HOST DISEASE FOLLOWING AUTOLOGOUS PERIPHERAL-BLOOD PROGENITOR-CELL TRANSPLANTATION IN CHRONIC MYELOID-LEUKEMIA

Myeloablation followed by haemopoietic reconstitution using autologous peripheral blood progenitor cells (PBPC) is applicable to some patien ts with CML, particularly where there is no allogeneic stem cell donor available, and interferon alpha has failed to achieve a significant c ytogenetic response. Cells lacking the Philadelphia (Ph) chromosome ca n be collected at the early phase of myeloid recovery after intensive chemotherapy, and reconstitution after autografting can be associated with prolonged suppression of the Ph positive clone. It is possible th at mechanisms other than this 'in vivo purge' may contribute to diseas e control, for example an autologous graft-versus-leukaemia effect. We report two patients in whom significant autologous graft-versus-host disease (auto-GVHD) has occurred, which has not previously been descri bed as a spontaneous event after PBPC autograft for CML. We postulate that mononuclear cells collected in an early phase of recovery after i ntense myelosuppression have the capacity to produce self-reactivity a fter autografting. These cells, which may include autoreactive T lymph ocytes or antigen-presenting dendritic cells, might mediate a useful g raft-versus-leukaemia effect.