Posted on November 16th, 2011 by
Less toxic cancer treatment followed by an allogeneic stem cell transplant is showing promise for older patients with advanced blood and bone marrow cancers such as multiple myeloma. These results were published in the Journal of the American Medical Association.
Multiple myeloma is a cancer of plasma cells, which are a special type of white blood cell that are part of the body’s immune system. Patients with multiple myeloma have increased numbers of abnormal plasma cells that may produce increased quantities of dysfunctional antibodies detectable in the blood and/or urine.
High-dose cancer treatment followed by a stem cell transplant may be used in the treatment of several types of hematologic cancers, including multiple myeloma. Stem cell transplants may use the patient’s own stem cells that were collected prior to cancer treatment (an autologous transplant) or stem cells donated by another person (an allogeneic transplant).
Because of the toxicities of high-dose allogeneic stem cell transplant, this treatment approach is often reserved for younger patients. In recent years, however, several transplant centers have evaluated less toxic regimens, including lower doses of chemotherapy, radiation, and/or biologic therapy prior to an allogeneic transplant. The less toxic regimens kill some cancer cells and suppress the patient’s immune system so that it won’t attack the donor cells. Once the donor cells are infused into the patient, they can recognize the patient’s cancer cells as foreign and mount an attack against the cancer. This approach is sometimes referred to as a “mini-transplant.”
To evaluate the safety and effectiveness of mini-transplants among older patients with advanced hematologic cancer, researchers conducted a study among 372 patients between the ages of 60 and 75. Patients were treated with low-dose total body irradiation alone or combined with fludarabine. Patients then received an allogeneic stem cell transplant from a related or unrelated donor.
These results are encouraging and suggest that mini-transplants are a viable treatment option for older patients with advanced hematologic cancer.
Reference: Sorror ML, Sandmaier BM, Storer BE et al. Long-term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies. JAMA. 2011;306:1874-1883.
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