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Related Experiment Videos

Autotransplants in acute leukaemia.

R P Gale1, M M Horowitz, A Butturini

  • 1Department of Medicine, UCLA School of Medicine 90024-1678.

British Journal of Haematology
|May 1, 1991
PubMed
Summary

Intensive chemotherapy before stem cell transplant is effective for acute lymphoblastic leukemia (ALL) but not acute myeloid leukemia (AML). Further research is needed for AML autotransplants and graft manipulation.

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Area of Science:

  • Hematology
  • Oncology
  • Stem Cell Transplantation

Background:

  • Autotransplantation is a treatment option for acute leukemias.
  • The effectiveness of pre-transplant therapy and graft manipulation varies between acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).
  • Graft-versus-host disease (GVHD) and graft-versus-leukemia (GVL) effects are critical considerations in transplantation.

Purpose of the Study:

  • To review current data on autotransplants for adults with acute leukemia in first remission.
  • To evaluate the efficacy of pre-transplant therapy and graft manipulation strategies.
  • To discuss the role of GVHD and GVL in the context of autotransplantation for ALL and AML.

Main Methods:

  • Review of existing data and clinical trial outcomes for acute leukemia autotransplantation.
  • Analysis of the impact of intensive pre-transplant chemotherapy and radiation.
  • Evaluation of strategies to remove leukemia cells from the graft and induce GVHD.

Main Results:

  • Intensive pre-transplant therapy is more effective in eradicating ALL than current chemotherapy.
  • More intensive therapy does not reduce relapse likelihood in AML.
  • Relapse due to re-infused leukemia cells is a concern in ALL autotransplants; GVL is distinct from GVHD and unlikely in autotransplants.

Conclusions:

  • Autotransplants for adult acute leukemia in first remission warrant study, but current data do not show superiority over existing therapies.
  • For ALL, focus should be on enhancing pre-transplant therapy efficacy and graft cell purging.
  • For AML, the effectiveness of intensive therapy needs resolution before graft manipulation can be meaningfully evaluated; testing new regimens is best in twins and HLA-identical sibling transplants without GVHD.

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