A Call to Change the Standard

Blood cancer bone marrow transplants should use stem cells from bone marrow says expert

(RxWiki News) Blood cancers, including leukemia and lymphoma, are sometimes treated with bone marrow transplants. The therapy uses stem cells to replace blood cells damaged by the cancer.

A leading expert has called for bone marrow to be used to gather adult stem cells from donors who aren’t related to the patient.

This would change the standard practice of using stem cells that are harvested from the blood that circulates throughout the body.

The reason for this recommendation is to decrease the number of transplant patients who suffer a serious and often debilitating condition known as chronic graft-versus-host disease (GVHD).

"Surgery is serious - ask questions."

Fred Appelbaum, MD, director of the Clinical Research Division at Fred Hutchinson Cancer Research Center, has called for this change based on a recent study that looked at how long transplant recipients lived and the side effects they suffered.

The phase III randomized trial was led by former Hutchinson Center transplant physician Claudio Anasetti, MD, who is now at the H. Lee Moffitt Cancer Center in Tampa, Florida.

A total of 551 patients were involved in the multicenter study conducted between 2004 and 2009. Researchers found that 53 percent of transplant recipients who received stem cells from circulating blood developed GVHD compared with 41 percent of those who had received stem cells from bone marrow.

"For the majority of unrelated transplants following a standard high-dose preparative regimen, bone marrow should be used since survival is equivalent with the two sources but the incidence of chronic graft-versus-host disease, which can be a debilitating complication, is significantly less with marrow," Appelbaum wrote in an editorial regarding the study.

GVHD occurs when a patient’s body sees transplanted stem cells as foreign invaders that need to be attacked. The condition, which can develop between 3 months and 3 years after the transplant, results in liver problems, skin rashes and diarrhea.

Using stem cells from circulating blood has been the standard source of stem cells gathered from people who are either related or unrelated to be patient.

These cells have been used because they’re easier to grow and harvest, and they tend to get accepted by the recipient’s body fairly easily.

Among blood cancer patients who need bone marrow transplants, roughly 70 percent must rely on the cells provided by an unrelated donor.

According to Dr. Appelbaum, some 5,500 Americans undergo this procedure every year.

"While this study should change practice, it will be interesting to see if it really does," Appelbaum wrote.

"The benefits of peripheral blood are seen early, under the watchful eyes of the transplant physician, while the deleterious effects occur late, often after the patient has left the transplant center."

Both the study and Dr. Appelbaum’s editorial were published October 18 in The New England Journal of Medicine. Funding information and financial disclosures were not publicly available.

Review Date: 
October 29, 2012