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What Makes Stem Cell Transplant Risky?

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Published on February 1, 2016

At a recent MPN town meeting, an online viewer asked the question, “What makes a stem cell transplant so risky?’  What are the pros and cons of this particular end-stage treatment?  Dr. Rami Komrokji of Moffitt Cancer Center answers with an honest benefit versus risk answer regarding this intensive procedure. 

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Transcript | What Makes Stem Cell Transplant Risky?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Esther Schorr:

She asks, “What makes a stem cell transplant so risky?  What are the pros and cons of that particular sort of end-state treatment?” 

Dr. Komrokji:     

Obviously, the appeal for the transplant, it’s probably currently the only curative option.  So again, statistically, we look at 100 patients that go to transplant.  Again, based on some of the disease features, because even when we say somebody is higher risk, they are not all homogeneous the same way.  But roughly there’s around 40 to 50 percent of the patients will be cured from the disease by going to transplant, which is the appeal.  So it’s not 100 percent, it’s 40 percent, let’s say roughly.  But the transplant is an intensive procedure.  The transplant, there is something we call transplant-related mortality, which is, unfortunately, death from complications from the procedure itself.

That, on average, [is] around 20 percent.  And then the transplant is a month’s stay in the hospital, typically somewhere close to the hospital for another two months, a year or two of quality of life being affected by frequent visits.  So you are always weighing the benefit and the risk.  If somebody has what we are calling a lower risk disease, and again, most of the time when we are talking about transplant, we are talking about fibrosis.

If somebody has 15 years estimated survival, you cannot justify the risk of a transplant that early.  But if somebody has the higher risk disease where you are saying based on what we see, the estimated survival is one to two years, then you become, say: okay, maybe we can justify a 20 percent chance of complications of the transplant, per se.  So we are always weighing the risk and the benefit.  In a way, it’s almost like the timing of the transplant.  Obviously, also there is [an] age limit on the transplant.  Age, per se, should not be a limit, age is function.

But, obviously, the benefit margin becomes less, the comorbidities, if patients have other medical problems.  So most of the time, transplants are done to the age of 65, considered almost immediately, or we push for them.  Between 65 to 70, 75 we become very selective, because you have to be in very good functional shape, and you have to have no major other medical problems.

Andrew Schorr:                   

Okay.  And just so everybody understands, we’re talking about allogeneic transplant.  So that’s where—you’ve heard about it—where somebody else’s cells are donated to you.  Your body has to be prepared for it.  And then you're getting somebody else’s cells, and that’s where you have this sort of graph versus leukemia effect, as well.  So the person’s healthy immune system is fighting with your sick immune system, and hopefully eventually wins.  I've learned how if you got a transplant from someone else who has a different blood type, your blood type actually changes to what theirs was. But the point is, it’s a big deal, but it is for some people—it may be indicated.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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