Autografting as first line treatment for chronic myeloid leukaemia

Interest in autografting for chronic myeloid leukaemia and its clinical relevance has revived in recent years. This followed observations that with various chemotherapeutic regimens it was possible to achieve, temporarily at least, peripheral blood and bone marrow that were Philadelphia negative. Bone marrow or peripheral blood progenitor cells could then be harvested and reinfused following a high dose procedure, hopefully eliminating any residual disease, and resulting in prolonged disease free survival. This ideal has not yet been successfully achieved with current strategies. Recent results indicate that eliminating residual disease with current chemotherapy is not normally achievable. The use of more sensitive technologies such as polymerase chain reaction has revealed persistent disease in most if not all apparently Philadelphia negative cases. This is confirmed by results where disease relapse occurs following transplant in these cases. Despite this, clinically relevant remissions are obtained and further trials are indicated. In this review present treatment is discussed and future strategies, using novel techniques as an adjunct to current treatment, are proposed that might improve on present results or even lead to the elusive goal of cure.