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Bone Marrow Transplant Survival Is Up Sharply Since Mid-2000s

Despite older, sicker patients, mortality rate fell by a third in 10 years

The overall risk of death after a bone marrow transplant dropped 34% between 2003−2007 and 2013−2017, according to an analysis published in the Annals of Internal Medicine.

Those gains stem from a sharp decline in transplant-related complications, said corresponding author George McDonald, MD, an emeritus member at Fred Hutchinson Cancer Research Center. The risk of dying from complications—mostly due to infections and diseases involving the liver, kidneys, and lungs—has fallen from 30% to 11% over the past 25 years.

Risk of death from relapse of cancer also declined, but nowhere near as steeply as that from complications. Recurrence of cancer remains a major challenge for the transplant field, he said.

Dr. McDonald also led an analysis in 2010 showing similar striking improvements for bone marrow transplant recipients from the 1990s through the early 2000s. The team's latest analysis shows that trend has continued. Dr. McDonald credits the improved outcomes to small, steady advances made at transplant centers by doctors, nurses, and specialists across every major medical discipline.

Bone marrow transplants are lifesaving treatments for patients with blood cancers and other diseases. During these procedures, patients first undergo chemotherapy and/or radiation to destroy their diseased bone marrow and to prevent rejection of donor cells. A donor's healthy, blood-forming stem cells are then given directly into the patient's bloodstream.

For the current study, Dr. McDonald and colleagues reviewed the outcomes of 1,148 patients who underwent a transplant at the Seattle Cancer Care Alliance between 2003−2007. They then compared them to 1,131 patients who had the procedures between 2013−2017. The most recent cohort was older and sicker when they had their transplant, Dr. McDonald said. Yet they still fared better than the previous group. In absolute terms, the frequency of overall mortality during 2013−2017 was 40%, and this proportion will increase with further follow-up, Dr. McDonald said.

Possible explanations for the improvement include better methods to prevent, detect and treat the infections that threaten immune-compromised transplant patients; identification before transplant of patients at high risk for fatal complications; the use of less-toxic chemotherapy and radiation regimens to prepare patients for transplant; advances in the prevention of graft-versus-host disease (GVHD); and lower doses of prednisone to treat GVHD, which has led to fewer infections.

Source: Fred Hutchinson Cancer Research Center, January 20, 2020


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