Predicting Better Survival for Kidney Cancer Patients After Transplant
According to a study published in the journal Cancer, three factors predicted better survival among patients with metastatic kidney cancer who had a reduced-intensity allogeneic stem cell transplant; these were better performance status, normal levels of C-reactive protein, and normal levels of lactate dehydrogenase.
The kidneys are a pair of bean-shaped organs located on each side of the spine that filter blood and eliminate waste in the urine through a complex system of filtration tubules. All of the blood in the body passes through the kidneys approximately 20 times an hour.
Renal cell cancer (RCC) is an uncommon form of cancer that is most often characterized by the presence of cancer cells in the lining of the filtration tubules of the kidney. Cancer that has spread outside the kidney to several and/or distant sites in the body is referred to as metastatic RCC.
The prognosis for patients with metastatic RCC is poor-median survival time is roughly 10 months. Researchers continue to explore new therapeutic approaches for these patients, including allogeneic stem cell transplantation.
Hematopoietic stem cells are immature blood cells produced in the bone marrow that mature into red blood cells (which carry oxygen to tissues), white blood cells (which fight infection), and platelets (which aid in blood clotting). In an allogeneic stem cell transplant, stem cells from a donor are infused into the cancer patient.
An important benefit of an allogeneic stem cell transplant is that donor cells will attack cancer cells (graft-versus-tumor effect). A reduced-intensity allogeneic stem cell transplant involves lower-dose therapy prior to the stem cell transplant. This approach reduces transplant-related mortality, but its effect against cancer is still being evaluated.
To identify factors that predict survival after a reduced-intensity allogeneic stem cell transplant, researchers in Europe evaluated 70 patients with metastatic RCC. The patients had undergone a median of two previous treatment regimens before receiving an allogeneic stem cell transplant.
Researchers evaluated the relationship between post-transplant survival and these factors:
- Number and sites of metastasis
- Performance status (measured on a scale of 0 to 100; 100 indicating normal functioning without complaints)
- Time interval between initial diagnosis and identification of metastases
- Results of several blood tests
Three of these factors were found to predict survival after stem cell transplantation:
- Performance status
- Serum levels of C-reactive protein (a protein associated with inflammation)
- Serum levels of lactate dehydrogenase (an enzyme associated with tissue damage)
Longer survival was linked with better pre-transplant performance status and normal levels of C-reactive protein and lactate dehydrogenase. Based on these three predictors of survival, researchers divided patients into two groups-low-risk and high-risk. Patients in the low-risk group survived for a median of 23 months after stem-cell transplantation, compared to only three and a half months among patients in the high-risk group.
The researchers conclude that use of three prognostic factors-performance status, serum C-reactive protein, and serum lactate dehydrogenase-may help identify patients who are the best candidates for reduced-intensity allogeneic stem cell transplantation.
Reference: Peccatori J, Barkholt L, Demirer T et al. Prognostic Factors for Survival in Patients with Advanced Renal Cell Carcinoma Undergoing Nonmyeloablative Allogeneic Stem Cell Transplantation. Cancer. Early Online Publication October 11, 2005.
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