Welcome to the third part of a series on Hemato-oncology.
Question: Dr. Chiragbhai, last time we discussed about what are stem cells and how they can be used for some diseases. You mentioned about case examples of how it is useful in field of Hemato-Oncology. Can you tell us more about that?
Answer: As we discussed last time, Stem Cell Transplant is an established treatment in the field of Hematology and Oncology. Following case examples will further help to clarify its role.
A six year old child has undergone 8 months of chemotherapy for Hodgkin’s disease. Mother reports that his lymph glands in neck never went away completely. They started increasing in size in next couple of months, and they came to us. This is primary refractory Hodgkin’s disease, and with any further traditional chemotherapy, chance of cure is nearly zero. This patient underwent autologus hematopoietic stem cell transplant, and is now in remission i.e. no sign of disease anywhere with whole body CT scans, even after almost 3 years.
Question: That is really wonderful. So is this child now cured?
Answer: Most likely yes. Chances of relapse are much lower now, and practically nil after 5 years. This case shows role of transplant when other therapies have failed. Second case illustrates a different area of usefulness, i.e. use during early part of therapy, before there is failure e.g. in a serious illness like acute myeloid leukemia where the chance of relapse is high, one would like to do everything possible to prevent any failure.
A 29 year old man, only son, recently married, whose wife is pregnant, comes with a white cell count of 180,000 (normal count should be within 4000 to 10,000). He is diagnosed to have acute myeloid leukemia, M1 type, a serious type of blood cancer. He is treated with standard therapy. Risk of recurrence is high and family wants to do the best possible to increase chance of cure as much as possible, with reasonably safe and proven method. He underwent autologus hematopoietic stem cell transplant. It is almost 3 years, and he is well, working actively.
Question: That is great. So, transplant can be done upfront as well for some diseases. One does not need to wait till there is a recurrence of disease.
Answer: Yes, of course. We all realize that many of these diseases do not give a second chance, and at time of recurrence, patient is often too sick to even undergo a transplant. Prevention is always better, if feasible. Transplant is now an integral part of treatment for acute myeloid leukemia, during initial therapy, as part of NCCN and other guidelines. Depending upon risk factors, and host factors, it could be autologus or allogeneic.
Similarly, Transplant is standard of care for another dreaded disease i.e. Multiple Myeloma. This is a type of cancer, for which life span is average of 2-3 years, and rarely up to 5 years, with traditional treatment. Transplant done as part of initial therapy, gives up to 10 years survival in 50% of patients. This is a very good achievement. And because of this reason, the number one indication for transplant in western world is Multiple Myeloma.
Patients with Multiple Myeloma and Acute Myeloid Leukemia must be evaluated for possible Transplant during initial phase of treatment.
Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496
Diplomate American Board of Oncology and Hematology. Ahmedabad. email@example.com
Shyam Hem-Onc Clinic. 402 Galaxy, Near Nehrunagar Circle, Ahmedabad.