AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR PATIENTS WITH ADVANCED CHRONIC MYELOGENOUS LEUKEMIA

We report on seven chronic myelogenous leukemia (CML) patients who rec eived autologous bone marrow transplantation (ABMT) using bone marrow (BM) cells while at the chronic phase (CP) under the various treatment s. Of the seven patients, four progressed to accelerated phase (AP) in 83-248 weeks after onset and three patients entered blastic crisis (B C) in 84-171 weeks after onset. All patients received high-dose chemor adiotherapy followed by infusion with 11.3 +/- 12.1 x 10(7) (average /- S.D.) of bone marrow mononuclear cells (BM-MNCs)/kg. IFN-alpha was resumed shortly after platelet recovery. Of the four patients in AP, o ne developed a recurrence of blastoma in 7 weeks, one progressed to se cond AP in 138 weeks after ABMT and two patients have survived the sec ond CP for 159 and 330 weeks since ABMT, respectively. One of them ach ieved the complete disappearance of Ph-1-positive metaphases for 33 we eks after ABMT. Of patients who received ABMT in BC, three relapsed wi thin 8 weeks and died in 9, 17 and 58 weeks after ABMT, respectively. Hematological recovery was delayed in four patients. Therefore, we ret rospectively re-evaluated the number of BM-MNCs collected through 50 p rocedures from 40 patients with CML-CP. The total MNCs obtained from 3 0 collections under IFN-alpha treatment was 27.4 +/- 30.9 x 10(8) cell s (average +/- S.D.), being significantly lower than that obtained fro m 20 collections in pre-treatment state or with single chemotherapy ot her than IFN-alpha treatment (81.8 +/- 68.2 x 10(8) cells) (P < 0.005) . The total number of MNCs correlated to white blood cell (WBC) count at BM collection (P < 0.01). which was also lower in the IFN-alpha(+) group than in the IFN-alpha(-) group (7.2 +/- 5.7 and 25.6 +/- 32.3 x 10(9)/l; P < 0.005). Our findings suggested that ABMT with the use of a sufficient number of progenitor cells might be helpful to CML patien ts in early AP and reach in extended periods of second CP. In addition , we suggest that BM collection is required before the start of IFN-al pha therapy because the total number of BM-MNCs correlated to the WBC count, which might be lower in IFN-alpha treatment. (C) 1997 Elsevier Science Ireland Ltd.