Clinical studies of autografting in acute lymphocytic leukaemia

The role of autologous marrow transplantation has been reviewed in this chapter. The transplantation results in first remission are difficult to interpret due to the prognostically heterogeneous patient population transplanted and the ever-changing natural history of first complete remission due to more aggressive conventional-dose chemotherapy regimen. The biological role of marrow purging, i.e. elimination of leukaemic cells from the graft, is yet unclear. It is the opinion of the authors that studies in second and subsequent remission can resolve burning issues such as the efficacy of various high-dose conditioning regimens and of different methods of elimination of leukaemic cells such as procedures based on immunological methods, monoclonal antibodies and on differences in sensitivity of stem cells and leukaemic cells to in vitro chemotherapy. It may well be that a large number of patients is needed and, therefore, a multi-centre study is indicated.