Autografting in chronic myeloid leukaemia

Autografting in chronic myeloid leukaemia (CML) has been performed at various stages in the disease using different regimens for the past 20 years. Early experience suggested that autografting in blastic transformation could prolong survival and, as with allogeneic transplantation, the use of autografting was then gradually extended to the chronic phase of the disease. Autografting techniques have been modified in recent years to exploit the presence of putative normal residual haemopoietic cells in the marrow of patients with CML. These include in vitro manipulations of marrow cells such as 10 day culture, purging with chemotherapeutic and other agents, and in vivo approaches such as collecting peripheral blood progenitor cells for autografting in the early recovery phase following high dose chemotherapy. Despite these advances, no large clinical trials have been carried out to address the question of whether autografting in CML extends the duration of chronic phase or prolongs survival. Therefore for the present autografting for CML must still be regarded as experimental, but interest in this approach continues since for the majority of patients allogeneic transplantation is not currently possible.