What role for autografting? A personal view Stephen G O’Brien
The purpose of this chapter is to consider some of the broad issues involved in the use of autografting for chronic myeloid leukaemia (CML): the results of various speciﬁc approaches have been discussed in the preceding chapters. Despite the considerable experience and strenuous efforts of numerous international clinical trial groups over many years, we are unfortunately still not in a position to clearly deﬁne the role of autografting in CML, since there are no prospective randomized survival data. The major confounding factor in our efforts to assess autografting is the advent of new ways to treat CML. Perhaps more than most of the haematological malignancies, the therapeutic options available for CML patients have changed markedly in the last ﬁve years or so – and particularly over the last 18 months. The development of interferon- (IFN-)-containing regimens, progress in allogeneic transplantation, and the advent of STI571 (Glivec; Gleevec) have made it much more difﬁcult to know which patients should be advised to undergo autografting, what type of autograft should be employed, and when it should be performed. In this chapter, as well as reviewing some basic concepts, I shall discuss a number of these
issues, as well as considering overall management strategies.