High-dose chemo-radiotherapy followed by autologous Philadelphia chromosome-negative blood progenitor cell transplantation in patients with chronic myelogenous leukemia

A. M. Carella, F. Chimirri, M. Podestà, A. Pitto, G. Piaggio, A. Dejana, E. Lerma, N. Pollicardo, F. Vassallo, M. Soracco, F. Benvenuto, M. Valbonesi, P. Carlier, R. Vimercati, E. Prencipe, A. M. Gatti, R. A. Ferrara, M. Incagliato, G. Florio, F. Frassoni

Research output: Contribution to journalArticlepeer-review

Abstract

Twenty-three patients with chronic myelogenous leukemia in early chronic phase (ECP) and not previously treated with alpha-interferon (IFN-α) (10 patients), in ECP but pretreated with IFN-α (12 months) (six patients) underwent autografting with Philadelphia (Ph) chromosome-negative blood progenitor cells (BPCs) (20 patients), or partially/totally Ph-positive BPCs (three patients), previously mobilized during the early phase of recovery after aplasia induced by intensive chemotherapy. The conditioning regimen consisted of high-dose chemotherapy alone or followed by total body irradiation (TBI). Recombinant G-CSF was given after BPCs infusion on day +8. All patients in ECP not pretreated with IFN-α are alive and five of them are Ph-negative in the marrow after autografting. Six of seven patients autografted with Ph-negative BPCs in the group of ECP pretreated with IFN-α (12 months are alive but Ph-positive after autografting. The other three patients of the same group died of procedure-related toxicity (two patients) and blastic transformation (one patient). Seventeen patients (10/10 ECP not pretreated with IFN-α; 5/7 ECP pretreated with IFN-α and 2/6 LCP pretreated with IFN-α) of 23 autografted patients were treated with IFN-α a IL-2. Toxicities after autografting were mostly related to myelosuppression, particularly thrombocytopenia. All patients of the two groups pretreated with IFN-α developed febrile episodes during the aplastic phase following BPCs reinfusion. No patient autografted in ECP and those not pretreated with IFN-α developed febrile episodes. This is also probably due to the use of i.v. antibiotic and antimicotic prophylaxis when neutrophils were ≤1x109/l after autografting. Greater toxicity was observed in patients pretreated with IFN-α, being lethal in two cases in LCF. In conclusion, the 'in vivo' manipulation approach employed in our institution is a safe procedure and it results in a high collection of Ph-negative cells in the blood if the cells are harvested: (1) in early chronic phase; (2) in early phase of recovery after chemotherapy-inducing aplasia; (3) in patients not extensively pretreated with IFN-α. The data presented here have shown encouraging trends in chronic phase of CML and offer new perspectives for patients without an HLA-identical donor or for patients who do not respond to IFN-α.

Original languageEnglish
Pages (from-to)201-205
Number of pages5
JournalBone Marrow Transplantation
Volume17
Issue number2
Publication statusPublished - Feb 1996

Keywords

  • CML
  • High-dose therapy
  • Ph-negative progenitor

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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