Critical issues in autologous bone marrow transplantation in adult acute leukemia

Autologous bone marrow transplantation (ABMT) is increasingly used to consolidate remissions, primarily in hematological disease. Various purging strategies have been developed to minimize the risk of reimplantation of tumor cells with the bone marrow autotransplant. Pharmacological purging with the oxazaphosphorine derivative mafosfamide has been studied extensively, and recent clinical data suggest that purging with mafosfamide may translate into superior remission duration if compared to nonpurged ABMT in acute leukemia. Chemical and experimental data relevant to mafosfamide-purging and clinical results are reviewed, with special emphasis on safety aspects.

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Photoinactivation of T-Cell Function with Psoralen and UVA Radiation Suppresses the Induction of Experimental Murine Graft-Versus-Host Disease Across Major Histocompatibility Barriers

Ullrich¹

1991

Journal of Investigative Dermatology

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Bone marrow transplantation is employed in the treatment of a number of hematologic and malignant diseases. A major complication is the induction of graft-versus-host disease. Whereas removal of T lymphocytes from the donor marrow effectively reduces the incidence of graft-versus-host disease, the incidence of graft failure often increases when T cells are depleted from the transplanted marrow. In the current study, photoinactivation of the donor cells with 8-methoxypsoralen coupled with exposure to long-wavelength ultraviolet radiation (PUVA therapy) was used to inactivate the response of the donor T cells against the host. PUVA therapy suppressed the ability of spleen cells to respond to alloantigen in the in vitro mixed lymphocyte reaction. The induction of acute graft-versus-host disease across complete major histocompatibility barriers in lethally X-irradiated mice was significantly suppressed after bone marrow transplantation with photoinactivated bone marrow cells. Long-term survivors demonstrated allogeneic reconstitution and partial restoration of T-cell function. Because PUVA therapy had no inhibitory effect on hematopoiesis, these data suggest that using phototherapy to inactivate the alloreactivity of T cells may provide an alternative to purging T cells from the donor marrow, thus suppressing both the incidence of graft-versus-host disease and the incidence of graft failure.

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Critical issues in autologous bone marrow transplantation in adult acute leukemia

Cited by 4 publications

References 114 publications

Bone marrow transplantation in acute lymphoblastic leukemia

Bone marrow transplantation in acute lymphoblastic leukemia

Bone marrow purging with mafosfamide ? A critical survey

Photoinactivation of T-Cell Function with Psoralen and UVA Radiation Suppresses the Induction of Experimental Murine Graft-Versus-Host Disease Across Major Histocompatibility Barriers

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