Bone Marrow Transplantation, Monoclonal Antibodies, Growth Factor Antagonists, Colony-Stimulating Factors

Abstract

M. Korbling (Heidelberg) opened session II by considering factors determining the applicability, problems and prospects of autologous and allogeneic bone marrow transplantation (BMT). With a trend towards dose excalation in chemotherapy into the supralethal range, BMT may be considered as a ‘rescue’ strategy if the primary toxicity is myeloid. Residual leukaemia in the patient may present problems; residual leukaemia in the marrow may be aided by a ‘graft versus leukaemia’ reaction of allogeneic marrow. Autologous BMT has a lower failure rate than allogeneic BMT, but there is no helpful graft versus leukaemia (GVL) reaction, and residual leukaemic cells must be purged prior to reinfusion. This is currently achieved by chemo- or immunoseparation, although long-term bone marrow culture utilizing recombinant growth factors is an attractive possibility. Different ‘conditioning’ regimes prior to BMT were also shown to variously influence leukaemic cell survival. Autologous BMT given in first remission for acute myeoblastic leukaemia (AML) showed 60% survival, with no further relapses after 1 year. Second remission transplants seemed to plateau at about 30%, but late remissions occur.