Bone marrow purging with mafosfamide — A critical survey

Summary Autologous bone marrow transplantation (ABMT) is increasingly used to consolidate remissions, primarily in hematological disease. Various purging strategies have been developed to minimize the risk of reimplantation of tumor cells with the bone marrow autotransplant. Pharmacological purging with the oxazaphosphorine derivative mafosfamide has been studied extensively, and recent clinical data suggest that purging with mafosfamide may translate into superior remission duration if compared to nonpurged ABMT in acute leukemia. Chemical and experimental data relevant to mafosfamide-purging and clinical results are reviewed, with special emphasis on safety aspects.Abbreviations ABMT autologous bone marrow transplantation - AL acute leukemia - AlDH aldehydedehydrogenase - ALL acute lymphoblastic leukemia - AML acute myelogenous leukemia - BFU-E erythrocyte burst forming units - CALLA common ALL antigen - CFU colony forming units - CFU-E erythrocyte CFU - CFU-GM granulocyte-macrophage CFU - CFU-Mix mixed CFU - CFU-Mk megakaryocyte CFU - CFU-S spleen CFU - CML chronic myelogenous leukemia - CP Cyclophosphamide - CR complete remission - DFP probability to remain disease free - DFS probability to survive disease free - EBMTG European bone marrow transplantation group - GM-CSF granulocyte-macrophage colony stimulating factor - GvHD graft versus host disease - ID-95 dose inhibiting 95% of colony growth - OH-CP hydroxy-cyclophosphamide - OOH-CP hydroperoxy-cyclophosphamide - TBI total body irradiation