According to an early online publication from the Journal of Clinical Oncology, factors have been identified that are associated with improved outcomes among patients with hematologic (blood) cancers who had received a stem cell transplant followed by a mini transplant.

High doses of therapy are often used in the treatment of hematologic cancers. Unfortunately, these high doses of therapy can kill immature blood cells, called hematopoietic stem cells. The blood cells typically mature into one of three types of blood cells: white blood cells that help fight infection; red blood cells that transport oxygen and nutrients to all tissues; and platelets that help the blood to clot.

If hematopoietic stem cell levels are reduced dramatically, patients may be at risk for life-threatening conditions. To protect patients from low stem cell levels, hematopoeitic stem cells are collected, either from the patient (autologous) or a donor (allogeneic), and infused following the high doses of therapy; the procedure is meant to restore blood cells to safe levels.

During an allogeneic stem cell transplant, the donor stem cells often recognize the patient’s cancer cells as foreign and attack them. Although this function may dramatically reduce the risk for a cancer recurrence, it may also cause a condition referred to as graft-versus-host disease (GVHD), where the donor stem cells attack the patient’s healthy tissues. GVHD may be acute, which tends to occur immediately following the infusion of donor cells and causes acute symptoms that ultimately resolve, or chronic, which occurs at a later stage and tends reduce a patient’s quality of life on a long-term basis.

If a patient is not able to locate a related donor that is a “match” for stem cell infusion, the patient will receive the donor cells from an unrelated individual. Unrelated donors tend to be associated with an increased risk for GVHD.

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Researchers from several studies recently analyzed data from 147 patients with a hematologic cancer whose disease had progressed despite having undergone a prior stem cell transplant. These patients were subsequently treated with a mini transplant, a procedure where the patient receives more conventional doses of therapy before stem cell infusion; this is intended to reduce the side effects associated with the high doses of therapy.

  • At three years death for reasons other than cancer progression occurred in 32% of patients who had a related donor and 28% of patients with an unrelated donor.
  • At three years cancer recurrences occurred in 48% of patients who had a related donor and 44% of patients who had an unrelated donor.
  • At three years overall survival was 27% for patients who had a related donor and 44% of patients with an unrelated donor.
  • Patients with non-Hodgkin’s lymphoma had improved outcomes compared to patients with multiple myeloma or Hodgkin’s lymphoma.
  • The following factors were associated with a reduced risk of a cancer relapse or cancer progression: partial or complete disappearances of detectable cancer immediately prior to infusion of stem cells and development of chronic GVHD.
  • The following factors were associated with an improved overall survival: partial or complete disappearances of detectable cancer immediately prior to infusion of stem cells; lack of other existing medical conditions at the time of stem cell infusion; and absence of acute GVHD after the infusion of stem cells.

The researchers concluded that patients with non-Hodgkin’s lymphoma whose cancer has progressed following high-dose therapy and an allogeneic stem cell transplant can achieve long-term survival with a mini transplant, particularly patients with anticancer responses achieved prior to stem cell infusion, those who develop chronic GVHD, those who do not develop acute GVHD, and those without other existing medical conditions. Furthermore, stem cells from unrelated donors appear to provide a highly effective alternative to donor stem cells.

Patients with non-Hodgkin’s lymphoma that has progressed following high dose therapy and a stem cell transplant may wish to speak with their physician regarding their individual risks and benefits of a mini transplant.

Reference: Baron F, Storb R, Storer B, et al. Factors Associated With Outcomes in Allogeneic Hematopoietic Cell Transplantation With Nonmyeloablative Conditioning After Failed Myeloablative Hematopoietic Cell Transplantation. Journal of Clinical Oncology. Early online publication August 8, 2006. DOI:10.1200/JCO.2006.06.9914.

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