Autotransplants in chronic myelogenous leukaemia: strategies and results

Autotransplants are increasingly used in chronic myelogenous leukaemia (CML). Most are performed in advanced leukaemia; now, autotransplants in chronic phase are being evaluated. Treatment involves high-dose chemotherapy with or without radiation followed by a transplant of previously cryopreserved stem cells derived from bone marrow or blood. The transplanted bone marrow may be manipulated in vitro to remove CML cells. Results vary. Transplants in advanced CML usually re-establish chronic phase but responses are brief. After transplants in chronic phase some recipients become Philadelphia chromosome negative for a year or more; others remain Ph-chromosome positive. There are insufficient data to show whether these early transplants prolong chronic phase duration or increase survival. The incurability of CML by conventional therapy should encourage further studies of this approach.