ABSTRACT
Chronic myelogenous leukemia (CML) is a disease that starts as an indolent non-life-threatening disorder, and evolves into a fulminant acute leukemic transformation following acquisition of somatic mutations which complement the Philadelphia chromosome (Ph) translocation. 1 Alpha-interferon has been shown to delay the onset of the blastic phase of this disease in 25% of individuals, 2 and allogeneic bone marrow transplantation is a curative therapeutic intervention which is applicable in an additional 25% of individuals. 3 Intensive systemic therapy followed by hematopoietic reconstitution with autologous cells has been used in this disease to provide a therapeutic option for individuals with CML who are not eligible for alpha-interferon or allogeneic bone marrow transplantation. This depends on collection of autologous bone marrow are peripheral blood cells early in the recovery from myelosuppression induced by conventional dose chemotherapy, as developed by Carella and his coworkers. 4 We have reproduced his findings in that we have found that diploid preparations of peripheral blood cells can be collected from 25–40% individuals so treated. The results of autologous bone marrow transplants, using autologous cells collected early in the phase of hematopoietic recovery from the myelosuppression induced by conventional dose chemotherapy, has suggested that the relapse that occurs following this procedure arises in part from leukemic cells present in the infused cells. 6 The use of retroviral 66marking to tag the infused cells in the autologous transplant has also suggested that leukemic cells in the transplant are also responsible for relapse. 7 In this review, we will summarize the data that have led to these conclusions.
