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Thursday, December 20, 2007

Mortality Remains Elevated Years after Allogeneic Hematopoietic Cell Transplantation

The following news from my e-mail file came from The Leukemia & Lymphoma Society news center. While, at first, alarming, the "hidden" positive in this release is that 2-year survival following a transplant can be expected to portend 80% survival for 15 years. And while survival rates following a transplant are far less than the general, healthy population, this research begs the question: What is the survival expectation without the treatment?


NEW YORK (Reuters Health) - Fifteen years after allogeneic hematopoietic cell transplantation (HCT), mortality rates among survivors are significantly higher than in the general population, according to a report in the November 15th issue Blood.

"Patients who survive 2 or more years disease-free after allogeneic HCT have an 80% probability of surviving for 15 years," Dr. Smita Bhatia from City of Hope National Medical Center in Duarte, California, told Reuters Health. "However, long-term (up to 15 years from HCT), the probability of dying prematurely is twice that of the general population. Survivors face a variety of obstacles, such as difficulty in holding jobs and in obtaining or retaining health and life insurance."

Dr. Bhatia and colleagues assessed late mortality and functional status in 1479 individuals who had survived 2 or more years after allogeneic HCT.

For the entire group, the probability of surviving was 86.6% at 5 years, 80.4% at 10 years, and 76.3% at 15 years from HCT, the authors report. Probabilities were somewhat higher for patients who did not suffer a relapse by 2 years after HCT.

Relative mortality was 78 times higher for years 2 to 5 than in the general population, 8 times higher for years 6 to 10, and 2-fold higher in patients followed for more than 15 years after HCT.

After relapse of primary disease, the leading causes of late mortality were chronic graft-versus-host disease, late infection in the absence of cGVHD, and treatment-related causes, the researchers note.

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Wednesday, December 19, 2007

When to seek a stem cell transplant for lymphoma?

One of the most critical issues for lymphoma patients deals with how and when to consider a stem cell transplant. This is most true when traditional and new-tech chemotherapy fails to provide lasting remission or a cure. The internet offers some insightful observations from a variety of resources, including this one ...

ASK THE DOCTOR -
Ann LaCasce, M.D.

Question:
My spouse is currently in the fourth round of R-CHOP for diffuse large B-cell lymphoma and is showing 50 percent reduction in affected nodes. Is stem cell transplant considered plan B when only a partial response to chemo is achieved, or is R-CHOP plus a transplant preferred by some oncologists in an attempt to achieve lasting remission (cure)?

Answer:
There have been a number of studies looking at the impact of stem cell transplant in patients who achieved remission following initial chemotherapy. The results have been controversial, and in the era of rituximab (Rituxan), which has improved the outcome for patients with diffuse large B-cell lymphoma when used in combination with CHOP, very few patients outside of a clinical trial will be offered initial stem cell transplant. If the disease does not go into remission, however, it would be standard treatment for the next step to be transplant, typically as long as the disease is responding to second-line chemotherapy.

(Medical editor’s note: CHOP+R, or R-CHOP, stands for cyclophosphamide, doxorubicin/hydroxydoxorubicin, vincristine/Oncovin and prednisone, plus rituximab/Rituxan.)

Related Links:
How Is Lymphoma Treated?
Life with Lymphoma: The ABCs of CHOP
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Important: We hope you find this medical and health information helpful, but it is no substitute for professional medical advice. For all personal medical concerns, including decisions about medications and other treatment options, you should always consult your doctor.

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