Welcome to the tenth part of a series on Hemato-oncology.
Question: Dr. Chiragbhai, thank you for explaining us in last few parts about transplant, including its procedure, cost, difference between Autologus transplant i.e. using one’s own stem cells, and Allogeneic transplant i.e. using someone else’s stem cells; number of transplants done worldwide per year and so few in India per year.
Before we move on to individual hematological cancers from next part, can you tell us about two issues that we have not discussed so far. Risks of transplant, and Results of transplant.
Answer: Thank you for these two excellent points. It is very important to understand that when we temporarily wipe out someone’s blood forming cells, there are significant risks involved. This is one of the reasons why we perform so few transplants in India, as this procedure needs a very good team and facility. Major risks are related to high doses of immunosuppressive drugs that are used, risk of serious infection and bleeding, immunity related risks like GVHD and late reactivation of serious infections, and others.
This understanding is important for both patient and referring doctor, as many people feel that Stem Cell Transplant is some magical treatment by which only good things will happen but it is completely risk free. Any new treatment faces this hype and excessive hope, that any disease can be cured with nearly 100% success rates.
In fact, we always have minimum three counselingsessions before transplant, with patient and family to make sure that they understand both risks and benefits clearly with realistic hope, and that they will be compliant with post transplant stringent follow up during initial period (for allogeneic).
Que: Thank you for this perspective. What about Benefits of transplant?
Ans: Well, in spite of these risks and small early mortality, this procedure number is increasing rapidly. Reason being no other alternative. Situations for which transplant is performed, generally have little or no other options. Following table will better clarify the benefits of this very important treatment, compared to other much more accepted treatments in medicine:
Condition Results with old Rx Results with new Rx
- Acute MI(heart attack) 90% survival 92% survival – Streptokinase
- Acute MI(heart attack) 90% survival 96% survival -Angioplasty/PAMI
- Relapsed Hodgkin’s Lymp 10% cure 50% cure – TRANSPLANT
- Relapsed NHL (lymphoma) 10% cure 50% cure – TRANSPLANT
- Relapsed AML(leukemia) 0% cure 30% cure – TRANSPLANT
- Myeloma 3 yr survival 8-10 year survival-TRANSPLANT
- Aplastic Anemia-severe 20% cure 70% cure – TRANSPLANT
- Thalassemia 0% cure 80% cure – TRANSPLANT
- MDS-Myelodysplastic 0% cure 30% cure – TRANSPLANT
- Many genetic disorders 0% cure 80% cure – TRANSPLANT
Since the baseline cure rate for these serious diseases is not very high, improvements achieved with modern treatment is not very obvious to doctors and patients both. But if you compare with options like streptokinase which we have accepted, the improvements are 10 times better or more e.g. absolute increase in survival 2% (92-90) to 40% (50-10) to 80% (80-0).
Also, no lifelong treatment is required after this transplant (generally 1-2 years only) compared with liver or kidney transplant where lifelong immune suppression is required.
Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496
Diplomate American Board of Oncology and Hematology. Ahmedabad. firstname.lastname@example.org
Shyam Hem-Onc Clinic. 402 Galaxy, Near Nehrunagar Circle, Ahmedabad.