Bone marrow transplantation: what is the question?

Article Abstract:

The transplantation of bone marrow has been used to treat various cancers and nonmalignant diseases. The timing of bone marrow transplantation remains a subject of controversy as it is dependent on the stage of disease. Twenty to 45 percent of patients undergoing bone marrow transplantation will survive free of disease; transplantation failure is commonly due to relapse or recurrence of the disease. Lymphoblastic leukemia is a blood cancer characterized by unrestrained growth of lymphoblasts, cells that give rise to lymphocytes, a type of immune cell. This blood cancer can be treated with chemotherapy and/or bone marrow transplantation. Chemotherapy for lymphoblastic leukemia was associated with a disease-free survival rate of 25 to 30 percent three to five years after diagnosis and high rates of remission (periods of decreased disease severity and symptoms). Factors that contributed to a poor outcome included age over 35 years, greater than 30 trillion white blood cells, the detection of a null cell phenotype, and late development of remission. Treatment of lymphoblastic leukemia by bone marrow transplantation was associated with a 40 to 63 percent disease-free survival rate for 2 to 10 years in patients experiencing their first complete remission. Ten to 40 percent of the patients relapsed; 90 percent of the relapses occurred within the first two years after treatment. The rates of increased disease-free survival and decreased relapse after bone marrow transplantation are even more impressive among children with this cancer. Patients with low-risk lymphoblastic leukemia should be treated with intensive chemotherapy alone. In high-risk lymphoblastic leukemia patients (including those over 50 years), a second course of chemotherapy following a relapse is associated with severe complications, therefore, bone marrow transplantation should be considered in the initial management of these patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, editorial

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Chemotherapy compared with bone marrow transplantation for adults with acute lymphoblastic leukemia in first remission

Article Abstract:

A comparison was made of the effectiveness of two approaches for treating acute lymphoblastic leukemia (ALL), a malignancy of blood cells in which bone marrow (where blood cells are made) becomes replaced by malignant tissue. The two approaches are chemotherapy and bone marrow transplantation; the latter method transplants bone marrow from a tissue-compatible donor (usually a sibling) into the patient. The study was retrospective and involved hospitals throughout the world; it evaluated the effects of treatment for 484 patients who underwent chemotherapy and 251 patients who received bone marrow transplants. All patients were treated during their first remission (period when the signs of the disease are no longer evident). The length of time after treatment that patients survived without a recurrence of leukemia was assessed. Results showed that the probability of surviving five years without leukemia was similar for both treatment groups (approximately 40 percent). Neither treatment conferred a survival advantage. While most treatment failures with chemotherapy were the result of relapse, the majority of failures with transplantation were due to complications of the procedure (graft-versus-host disease). It is likely that an effective approach to treating ALL is to administer chemotherapy first, saving transplantation for those who relapse. As many as 20 percent of relapsing patients after chemotherapy are cured by transplantation. At present, it cannot be said that bone marrow transplants offer advantages over chemotherapy for treating adult ALL in first remission. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis

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Peripheral blood stem cell and bone marrow transplantation for solid tumors and lymphomas: hematologic recovery and costs, a randomized, controlled trial

Article Abstract:

Peripheral blood stem cell (PBSC) transplantation appears to be more cost effective and give better short-term results than autologous bone marrow transplantation in patients undergoing chemotherapy for cancerous tumors or lymphomas. Researchers randomly assigned 129 patients to either PBSC transplantation or to autologous bone marrow transplantation. PBSC transplantation recipients returned to normal blood cell production faster than autologous bone marrow transplant recipients. PBSC transplantation cost 17% less in adults and 29% less in children. However, PBSC transplants may contain cancerous cells. The effect on the relapse rate remains unknown.

Health aspects, Stem cells, Lymphomas, Tumors

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