Background. Autologous bone marrow transplantation (ABMT) after myeloablative therapy is an alternative treatment for patients with malignant diseases who lack suitable donors. The rationale for marrow purging is based on differential sensitivity to chemotherapy between leukemic and normal stem cells. Methods. ABMT procedure was performed by in vitro marrow purging with mafosfamide in patients diagnosed with acute myeloid leukemia (AML) and acute lymphoblastic leukemia Philadelphia chromosome positive (ALL Ph+) in first remission, who do not have HLA identical donor. Eight patients (median age 9 years): four with AML, three with ALL Ph+ and a patient with ALL in fourth complete remission, received bone marrow purged with mafosfamide. Conditioning regimen was performed with Busulfan 16 mg/ Kg and Etoposide 50 mg/Kg. Results. The median time to reach an absolute neutrophil count >0.5 x 109 was day +14 and for platelet recovery was day +46 after transplantation. The disease free survival (DFS) was 62.5% during 18 months of follow-up. Conclusions. Marrow purging has the disadvantage of time prolongation of engraftment, nevertheless, in our group of patients the occurred earlier than previously reported and appeared to offer the greatest benefit to transplanted patients, especially those with AML
Autologous bone marrow transplantation for high risk acute lymphoblastic leukemia: clinical relevance of ex vivo bone marrow purging with monoclonal antibodies and complement