In this article, we will discuss the Role of Autologous Bone Marrow (stem-cell) Transplantation in the Management of Acute Leukemia. So, let’s get started.
Autologous Bone Marrow (stem-cell) Transplantation-peripheral blood stem cell transplantation: In autologous bone marrow transplantation, the patient’s own marrow is harvested and frozen to be given back again after achieving a good remission with intensive chemotherapy. It is indicated in patients of acute leukaemia in whom good or complete remission has been achieved with chemotherapy and acceptable HLA-matched donor is not available for allogenic bone marrow transplantation. This procedure carries a lower-mortality rate than the allogenic BMT but the greatest disadvantage of this procedure is high relapse rate (50%). Autologous bone marrow transplantation in acute leukaemia is better than chemotherapy alone.
Stem cells for transplantation were originally obtained by harvesting them from the bone marrow. Recently, they have been collected from the peripheral blood during recovery phase following a period of chemotherapy induced marrow hypoplasia. The dose of stem cell collected from the peripheral blood is much greater than that of harvested from the marrow, hence, making stem cell transplantation easier and a reduction in transplant-related mortality to less than 10% in patients under 55 years of age.
Prognosis: Without treatment, the median survival rate of patients with acute leukaemia is about 5 weeks. Median survival for ALL patients is about 2 years and for AML patients about 1 year if remission is achieved. The poor prognostic features in acute leukemia are given below:
- Increasing age
- Male sex
- High leucocyte count at the time of diagnosis
- CNS involvement in ALL at diagnosis
- Cytogenetic abnormalities
- Presence of Philadelphia chromosome in ALL