Rationale

CML derives from disordered proliferation of a Ph+ clone that arises from an early hematopoietic stem cell. Marrows of patients with CML may contain chimerism between malignant Ph+ and non-malignant Ph-cells. The results of chemotherapy, interferon, or imatinib to induce cytogenetic responses, as well as the ability to grow CFU of Ph~ cells from cultured CML marrow, demonstrates this point. Collecting stem cells purified for Ph~ clones has been the elusive goal of studies of autologous transplant for CML. To this end, a number of purging approaches have been investigated. However, data regarding syngeneic transplantation show a high relapse rate and suggest that graft versus leukemia may be equivalent to—if not more important than—myeloablation and infusion of a tumor-free graft.13

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