ABSTRACT
The major obstacle to a successful outcome after intensive therapy supported by autografting for acute myelogenous leukemia (AML) and chronic myeloid leukemia is recurrent disease. This chapter reviews the Vancouver experience with cell culture based autograft manipulation protocols designed to develop and test strategies towards the ultimate realization of this goal for the treatment of patients with myeloid leukemia. Long-term culture (LTC) of hematopoietic cells refers to an in vitro system where stromal cells replace exogenously added soluble growth factors for the stimulation of very primitive hematopoietic cell proliferation, self-renewal and differentiation. In 1986, the group at the Christie Hospital in Manchester reported on the results of autografting a patient with AML in relapse with marrow cells that had been cultured under conditions previously found to enable establishment of LTC from single inoculum of unseparated marrow. Pilot studies have been conducted to evaluate use of cultured hematopoietic cells as autografts in 36 patients with CML and 24 patients with AML.
