Summary:Keywords: hematopoietic progenitors; microenvironmental progenitors; acute myelogenous leukemia; chemotherapy; LTC-IC; hematopoietic engraftment Since reduced marrow cellularity and prolonged pancytopenia following autologous bone marrow transplantation (ABMT) have been frequently observed in patients with acute myelogenous leukemia (AML)The structural integrity of the hematopoietic system is included in the AML10 GIMEMA/EORTC trial, the maintained by a relatively small population of selfquestion was raised to what extent hematopoietic and renewing stem cells which can differentiate to produce promicroenvironmental progenitor cells were involved in genitors committed to terminal maturation. 1 The developthese patients. Marrow hematopoietic progenitors were ment of hematopoietic cells in vivo occurs in intimate investigated by a short-term methylcellulose assay association with a heterogeneous population of mesenchyquantitating multipotent CFU-Mix, erythroid BFU-E mal, connective tissue type cells and their associated and granulocyte-macrophage CFU-GM, as well as a biosynthetic products, which constitute the stromal tissue long-term assay quantitating long-term cultureof the bone marrow.
Stromal cells of the hematopoietic initiating cells (LTC-IC). The marrow microenviron-microenvironment include fibroblasts, endothelial cells, ment was studied by evaluating the incidence of fibroadipocytes, and macrophages. 2 Based on a number of studblastoid progenitors (CFU-F) and the capacity of stroies, 3 the existence of self-renewing stromal stem cells with mal layers to support allogeneic hematopoietic multilineage differentiation capacity and capable of generprogenitors. As compared to normal controls (n = 57), ating progenitors with restricted development potential, AML patients (n = 26) showed a statistically significant including fibroblast, osteoblast and chondrocyte progenireduction of the mean (± s.e.m.) number of CFU-Mix tors, has been hypothesized.
4-6(5.3 ± 0.6 vs 0.8 ± 0.2, P р 0.0001), BFU-E (68 ± 5 vs Standard-and high-dose therapies currently used for the 20 ± 4, P р 0.0001), CFU-GM (198 ± 11 vs 144 ± 15, P treatment of hematological and nonhematological malig-р 0.008), and LTC-IC (302 ± 46 vs 50 ± 8, P р 0.001).nancies induce transient or permanent damage of hematoThe mean (± s.e.m.) incidence of marrow CFU-F was poietic and stromal progenitor cell compartments.
7,8not significantly reduced as compared to normal conDespite such chemotherapy-induced defective progenitor trols (48 ± 6 vs 52 ± 7, P р 0.73). Seventeen AML strocell growth, the reinfusion of autologous marrow can reconmal layers were tested for their capacity to support the stitute the hematopoietic system, even in acute myelogengrowth of allogeneic hematopoietic progenitors. Seven ous leukemia (AML) patients treated with remission inducsamples failed to support any progenitor cell growth, tion regimens exerting a significant marrow toxicity.
9,10seven had a significantly lower supportive activity as Recently, therapeutic trials have been...