Autologous bone marrow transplantation (BMT) in null cell type acute lymphocytic leukemia (Null-ALL) was carried out after depletion of leukemia cells from transplanted marrow.
Patients' autologous bone marrow cells were harvested during remission and treated in vitro with baby rabbit complement (50%) and three monoclonal antibodies (NL-1 10μg/ml anti-CALLA IgG2a, NL-22 10μg/ml IgM and HL-47 10μg/ml IgM) reactive to Null-ALL cells, and then cryopreserved. Only cases whose leukemia cells were more than 90% lysed by in vitro treatment with monoclonal antibodies and complement were selected for this protocol.
Seven patients (6 y. o. M, 11F, 17M, 22M, 30M, 40M and 40M) were transplanted with the antibody-treated bone marrow cells during the first remission (six cases) or the second remission (one case) after preconditioning with intensive chemotherapy (cytosine arabinoside 2g/m² 4 doses at day -6, -5, -4. cyclophosphamide 60mg/kg 2 doses at day -5, -4) and total body irradiation (250_??_300 cGy at day-2, -1. 4 doses).
Good preservation of bone marrow was demonstrated in all seven cases studied, and infused bone marrow mononuclear cells were ranged from 0.11×10⁸/kg to 0.35×10⁸/kg. Clinically, prompt recovery of white blood cells was observed in six cases, and platelet recovery was prolonged in three cases. Four cases have continued complete remission for 42, 29, 24 and 21 months after BMT, while two cases relapsed after seven and six months remission, and one case had died of interstitial pneumonia in remission after 5months of BMT. These results suggested that autologous BMT with these three monoclonal antibodies may be an effective mode of therapy for high risk Null-ALL patients.

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The probability of long term survival for allogeneic graft patients was 67% for ALL, 62% for ANL and 61% for CML in the 1 st remission or 1 st chronic phase of each leukemia. The major causes of death were interstitial pneumonia, relapse and infection. On relationship of GVHD and the long term survival, the probability of 5 years survival was 41%, 60% and 33% in grade 0, I and II_??_IV of acute GVHD respectively and it was 70% with chronic GVHD and 40% without. The difference might be due to that of relapse rate of leukemia. This may suggest that GVHD both acute and chronic might have an ability that can suppress the relapse of leukemia, i.e. GVL reaction. Interstitial pneumonia occured in 35% of allograft patients and was often lethal complication (70%). Among many of prophylaxis tested, the followings were effective, a lower dose rate of total body irradiation, the selection of CMV-seronegative platelets donor, and the prophylactic administration of anti-CMV high titer globulin. Colony stimulating facter of human urine was also effective for shortening the granulopenic period after transplantation to prevent severe infections.

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[in Japanese]

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