Abstract
Total body irradiation (TBI) was originally thought to be capable of eradicating leukemia, but with time it became apparent that we cannot eradicate this disease with TBI.1 Today we know that graft-versus-leukemia effects are more important than previously thought. Strong evidence came from the depletion of T cells from the graft for the prevention of graft-versus-host disease (GVHD): the rate of relapses increased particularly in chronic myelogenous leukemia (CML),2 and in some patients the graft was even rejected. However, some patients with refractory acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) were treated with intensive chemotherapy and a single dose of TBI and are alive and in remission today more than 30 years later. Therefore, the question arises whether immune therapy with lymphocytes from the stem cell donor can eradicate leukemia stem cells without the help of high-dose TBI or stem-cell toxic chemotherapy. The best clinical evidence for leukemia stem cells is provided by the occurrence of late relapses presumably arising from radio- and chemo-resistant, quiescent stem cells. Late relapses after allogeneic stem cell transplantation were observed in patients treated for CML3 and less frequently in those treated for AML and ALL.4 In these patients stem cells of leukemia may have been recruited from a quiescent state and may have given rise to open relapse.
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