March 8, 2009

Stem Cell Transplant Procedures Vary Throughout the World


Stem Cell Transplant Procedures Vary Throughout the World

Stem cell transplant practices vary substantially among physicians treating adults and children with hematologic malignancies (cancers of the blood or bone marrow such as leukemias and lymphomas). These findings were published in the Journal of Clinical Oncology.

Stem cell transplant involves the use of high doses of therapy to kill more cancer cells than standard doses. However, the high doses also destroy normal cells, such as blood cells. The destruction of blood cells, particularly immune cells, red blood cells, and platelets, can lead to life-threatening side effects.

To compensate for the low and dangerous levels of blood cells following high-dose therapy, patients receive hematopoietic stem cells, or immature blood cells. These stem cells mature into the three types of blood cells. In an autologous stem cell transplant, the patient’s own stem cells are collected prior to high-dose therapy and then re-infused following therapy. Allogeneic stem cell transplant, on the hand, utilized stem cells from a donor who may be related or unrelated to the patient.

The current study, conducted internationally via the Internet, evaluated the decision-making process of physicians specializing in stem cell transplant for adult and pediatric patients. Further analysis identified physician and transplant center characteristics that may be associated with treatment decisions. Analysis of 526 respondents revealed wide variations in management of hematologic malignancies and use of stem sell transplant.

  • Pediatric and adult physician management strategies varied significantly in the treatment of acute myeloid leukemia, acute and chronic graft-versus-host disease, and the choice of transplant source for patients with aplastic anemia (decreased production of white blood cells, red blood cells, and platelets by bone marrow).
  • Among physicians treating adults, there appeared to be little agreement on which factors determined how aggressively to treat the patient prior to stem cell transplant.

Results of the study emphasize the variety of worldwide transplant practices. Local factors or biases seem to be responsible for similar patients receiving different treatment procedures. These results highlight the need for further research to clarify areas of controversy..

Reference: Lee, S., Joffe, S., Artz, A., et al. Individual physician practice variation in hematopoietic cell transplantation. Journal of Clinical Oncology. 2008. (26): 2162-2170.

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