WEDNESDAY, Nov. 24 (HealthDay News) -- Clinicians have made
remarkable advances in treating blood cancers with bone marrow and
blood stem cell transplants in recent years, significantly reducing
the risk of treatment-related complications and death, a new study
Between the early 1990s and 2007, there was a 41 percent drop in
the overall risk of death in an analysis of more than 2,500
patients treated at Fred Hutchinson Cancer Center in Seattle, a
leader in the field of blood cancers and other malignancies.
Researchers from the Fred Hutchinson Cancer Center, who
conducted the study, also noted dramatic decreases in treatment
complications such as infection and organ damage.
The study was published in the Nov. 24 issue of the
New England Journal of Medicine
"We have made enormous strides in understanding this very complex procedure and have yielded quite spectacular results," said study senior author Dr. George McDonald, a gastroenterologist with Hutchinson and a professor of medicine at the University of Washington, in Seattle. "This is one of the most complex procedures in medicine and we understand a lot of complications we didn't before."
Dr. Mitchell Smith, head of the lymphoma service at Fox Chase
Cancer Center in Philadelphia, feels the general positive trend --
if not the exact numbers -- can be extrapolated to other care
"Most of the things that they've been doing have been generally adopted by most transplant units, although you do have to be careful because they get a select patient population and they are experts," he said. "The smaller centers that don't do as many procedures may not get the exact same results, but the trend is clearly better."
Treatment of high-risk blood cancers such as leukemia, lymphoma
and myeloma was revolutionized in the 1970s with the introduction
of allogeneic blood or bone marrow transplantation.
Before this advance, patients with blood cancers had far more
limited options. The high-dose chemotherapy or radiation treatments
designed to kill blood cancer cells (which divide faster than
ordinary cells) often damaged or destroyed the patient's bone
marrow, leaving it unable to produce the blood cells needed to
carry oxygen, fight infection and stop bleeding. Transplanting
healthy stem cells from a donor into the patient's bone marrow --
if all went well -- restored its power to produce these vital blood
While the therapy met with great success, it also had a lot of
serious side effects, including infections, organ damage and
graft-versus-host disease (GVHD), which were severe enough to
prevent older and frailer patients from undergoing the
But the past 40 years has seen a lot of improvements in managing
The authors of this study compared the experiences of 1,418
patients who underwent their first allogeneic transplants at
Hutchinson between 1993 and 1997 with those of 1,148 patients who
had the same procedure a decade later, between 2003 and 2007.
Patients had types of leukemia, lymphoma, multiple myeloma and
myelodysplastic syndrome and received peripheral-blood stem cells
or bone marrow from unrelated donors. In the later period, more
peripheral-blood stem cell transplantations were done and fewer
bone marrow transplantations were performed.
The overall rate of death without a relapse declined 52 percent,
and the overall early death rate (200 days post-procedure) without
a relapse dropped 60 percent.
About 55 percent of patients undergoing transplantations in the
earlier period survived a year, compared with 70 percent of those
in the later period.
And there were improvements in the rates of just about every
complication, even though the patients treated in 2003-2007 were
older and sicker than those treated a decade earlier. For instance,
the chances of developing severe graft-versus-host disease went
down by 67 percent over the decade, partly thanks to better drugs.
There was also less disease caused by infections and less
treatment-related damage to the liver, kidney and lungs, the
The authors can't be sure about the reasons for the
improvements, but speculate that it has to do with more controlled
chemotherapy doses; less toxic "conditioning" to rid the body of
attack lymphocytes; better detection and prevention of viral,
bacterial and fungal infections, as well as the availability of
better antifungal (and other) medications as well as better
matching of donors and recipients.
Use of peripheral-blood stem cells, which increased during the
time frame, also is easier on the patient, they noted.
In addition, the introduction of the drug Gleevec to treat
patients with chronic myeloid leukemia has eliminated the need for
transplantation in these patients, Smith added.
"I think we all feel comfortable that we are doing much better than we were doing 10 years ago, particularly in terms of early deaths and preventing and managing toxicity, and a lot of it has come out of this group [the Fred Hutchinson Cancer Center]," said Smith. "They're the ones that lead the way."
Dr. Nelson Chao, head of the transplantation program and
professor of medicine at Duke University in Durham, N.C., agreed
that "a lot of these treatments are now standardized in many
McDonald and five other authors reported ties with
pharmaceutical companies. The study was funded by the U.S. National
Institutes of Health.
The Leukemia & Lymphoma Society has more on
stem cell transplantation.
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