Autologous bone marrow transplantation as treatment for bad-risk first remission acute lymphoblastic leukaemia

Treatment of poor-risk acute lymphoblastic leukaemia (ALL) with standard chemotherapy combinations is associated with a cure rate of less than 40% (1–3). We have therefore embarked on a programme of autotransplantation over the last six years. Transplantation was performed early in first remission, incorporating three approaches to improve the eradication of residual disease in both the patient and the re-infused marrow. Our first approach was to use melphalan and total body irradiation (TBI), a successful conditioning regimen for acute myeloid leukaemia (AML), (4, 5). Secondly, we investigated the use of purging the autografted marrow with a monoclonal antibody technique. In addition, patients were given maintenance chemotherapy with 6-mercaptopurine and methotrexate for two years after transplantation on the assumption that radical reducton of tumour load by the transplant procedure would improve the chances of chemotherapy eliminating minimal residual disease.