Competitive repopulation in leukemic and normal bone marrow

The success of chemotherapy in leukemias in which the marrow appears entirely replaced by leukemic cells must be due to the persistence of some normal stem cells. The implied competition between leukemic and normal stem cells is thus akin to the competition between donor and host cells in irradiated animals. A review of that competition points to the importance of the quantitative relationships between the competing stem cells, even when one of the competing stem cell clones has a proliferative advantage. Pursuing that analogy, it is suggested that stimulating the surviving normal stem cells by appropriate combinations of cytokines may be of therapeutic benefit, once the tumor load has been reduced by chemotherapy. Complete eradication of leukemic cells may not be necessary, if surviving normal cells could gain ascendancy over the residual leukemic cell clones.