Purged autologous bone marrow transplantation in the treatment of acute leukemia.

Allogeneic bone marrow transplantation is an established treatment for acute leukemia. It is largely limited to patients with HLA-matched sibling marrow donors and those for whom phenotypically HLA-matched unrelated donors can be identified. There therefore exists a significant number of patients for whom this potentially curative therapy is not available. Autologous marrow transplantation might be an alternative approach, but concern about the infusion of leukemic cells with the autologous marrow exists. Multiple methods for removing neoplastic cells from marrow (marrow purging) have been developed. Clinical results using purged marrow in treating patients with acute non-lymphoblastic leukemia in second or greater remission by autologous bone marrow transplantation approach those observed in allogeneic marrow transplantation. Current investigations include the development of more effective cytoreductive regimens, use of recombinant hematopoietic growth factors, improvement of marrow purging techniques, and enhancement of cell-mediated anti-leukemic activity in patients receiving autologous marrow transplants.