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Review
. 2021 Jul 15;3(3):83-95.
doi: 10.2991/chi.k.210703.002. eCollection 2021 Sep.

History and Development of Autologous Stem Cell Transplantation for Acute Myeloid Leukemia

Norbert Claude Gorin  1
Affiliations
Review

History and Development of Autologous Stem Cell Transplantation for Acute Myeloid Leukemia

Norbert Claude Gorin. Clin Hematol Int. .

Abstract

This review describes the development of cryopreservation, the birth of autologous stem cell transplantation (ASCT) and its past and present use to consolidate adult patients with acute myelogenous leukemia (AML). It summarizes the first autografts in patients in relapse, the experience of autografting in complete remission (CR), using bone marrow unpurged or purged in vitro with cyclophosphamide-derivatives, and the important shift to peripheral blood stem cells. The review also discusses the results of recent studies in favor of the use of ASCT to consolidate good- and intermediate-risk patients who reach CR with no detectable minimal residual disease, and those which support the inclusion of maintenance therapy post autograft with hypomethylating agents, anti-BCL-2, and, possibly, in the future, anti AML chimeric antigen receptor-T cells. Carefully applied to well-selected patients, ASCT may regain interest, because of its simplicity, its reduced toxicity, lower non-relapse mortality and better quality of life.

Keywords: Autologous stem cell transplantation; acute myelogenous leukemia; cryopreservation; history; review.

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Conflict of interest statement

The author declares no conflicts of interest.

Figures

Figure 1
Figure 1
The first programmed freezing apparatus. (A) « Cryoson » (Midden Beemster, The Netherlands) used at Hôpital Saint-Antoine, Paris, from 1974 to 1995. (B) Nicool, the freezing apparatus from “Air liquid” used afterward. (C) The ideal freezing curve with a −1°C/min constant cooling rate and supercooling at the release of the heat of fusion to avoid thermic shock.
Figure 2
Figure 2
The preclinical canine model. (A) A well cryopreserved plasmocyte with no ergastoplasm disruption. (B) Composite of total leukocyte counts for dogs submitted to total body irradiation followed by infusion of various doses of frozen autologous marrow stored for 2 months.
Figure 3
Figure 3
The first autologous stem cell transplantation in man (1976). (A) A polyolefin bag containing marrow of one of the first autografted patients, squeezed between the two plates presented on Figure 1 and frozen following a program of −1°C/min with abrogation of the heat of fusion. Polyolefin bags were fragile and could break on thawing. They were later replaced by Teflon–Kapton bags. (B) Marrow aspirate 14 days after the first patient was autografted at Hopital Saint-Antoine, Paris. The patient received his marrow collected in first remission of acute myelogenous leukemia and cryopreserved in the gas phase of liquid nitrogen (−140°C) in 1976: the first erythroblastic nest attesting for engraftment.
Figure 4
Figure 4
One possible scheme of a modern randomized study reassessing ASCT for the consolidation of patients with AML in MRD negative CR.
See this image and copyright information in PMC

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