ABSTRACT
The idea that allogeneic immunity conferred by bone marrow transplantation (BMT) could exert an antileukemic effect has its origins in experiments in mice by Barnes and Loutit1 in 1956, who showed that allogeneic BMT prolonged survival from a lethal experimental leukemia at the same time as causing graft-versus-host disease (GVHD). Clinical investigators, however, have been slow to appreciate the potential of this so-called graft-versus-leukemia (GVL) effect. Only in the last decade have concerted attempts to characterize and optimize GVL been made. The study of GVL reactions in chronic myeloid leukemia (CML) is particularly rewarding, since, of all leukemias, CML is the most susceptible to control and eradication by alloimmune processes. Furthermore, the study of GVL in CML has been greatly facilitated by our ability to quantitate residual disease using the polymerase chain reaction (PCR) to detect BCR/ABL mRNA.2,3 In this chapter, the clinical features of GVL in CML are summarized, cellular mechanisms are outlined, and current and future immunotherapeutic applications are discussed.
