Can Long-Term Bone Marrow Culture Eliminate Leukemia Cells?

In chronic myeloid leukemia (CML) and acute myeloblastic leukemia (AML), experimental studies have shown growth advantage of the residual normal progenitor cells under long-term culture conditions. In some instances, this culture system has been used as a tool for purging bone marrow, before autotransplant. In this review, we discuss the efficiency of this technique, with respect to the persistence of sufficient numbers of normal stem and/or progenitor cells, capable of restoring hemopoiesis following pre-transplant conditioning regimens, and in relation to the elimination of leukemia cells, capable of causing relapse. Both issues are complex, and mostly still obscure. However if one considers the clinical outcome of patients receiving unpurged autografts, it is unlikely that long-term bone marrow cultures (LTBMCs) will be of substantial benefit in reducing leukemia relapse. Furthermore the clinical efficacy of this technique will in our opinion be difficult, if not impossible, to prove.