Normal Life Span After Bone Marrow Transplant

EMBARGOED FOR RELEASE: JUNE 30, 1999, 4:00 p.m. CST

Medical College of Wisconsin Researchers Find Normal Life Span for Some Patients After Bone Marrow Transplant

Doctors know that bone marrow transplants give some patients with leukemia and other life-threatening diseases a new lease on life. They also know that the procedure is difficult and that patients receiving transplants are at risk for serious, and sometimes fatal, complications in the early post transplant period. What was less well-known is how patients who survive these early complications do over the long term. Now researchers with the International Bone Marrow Transplant Registry (IBMTR) at the Medical College of Wisconsin have found that most of these patients are cured and that, in some groups, survival rates eventually approach that of the general population.

This study, chaired by Gerard Socie, M.D., Ph.D., of Hopital St. Louis in Paris, was based on a statistical analysis of patients receiving transplants in 221 transplant centers in more than 30 countries. It was reported in the July 1, 1999 issue of the New England Journal of Medicine.

"The good news from this study is that most patients who survive early transplant complications appear to be cured and have a very good prognosis for resuming a normal life," says Mary Horowitz, M.D., M.S., scientific director of the IBMTR and cancer specialist with the Medical College Cancer Center. "However, the other important message is that transplant survivors remain at risk for potentially fatal complications for many years. They should be followed closely so that these complications can be diagnosed and treated early. This is MORE

BMT Life Span/Only Add especially important since there are now more effective interventions available to treat complications, like leukemia relapse, which might further improve the prognosis of these patients." The IBMTR, an international collaborative research group headquartered at the Health Policy Institute of the Medical College, evaluated 6,691 patients who received transplants from healthy related or unrelated donors for acute myelogenous or lymphoblastic leukemia, chronic myelogenous leukemia or aplastic anemia. All had survived the early post transplant period and were alive and free of their original disease two years after their transplant. Researchers then investigated how much longer they lived and, for those who died, the primary causes of death.

IBMTR researchers calculated that the probability of living five more years beyond the original two was 89 percent. Using statistical methods, they compared this survival rate to that of a general population, matched for age, gender, and nationality. They found that patients receiving transplants for aplastic anemia had survival rates similar to the general population by six years after transplant. Patients receiving transplants for leukemia had survival rates lower than the general population for at least nine to 12 years post transplant although their mortality risk decreased over time.

Chronic graft-versus-host disease, a frequent transplant complication, was the most common cause of death for leukemia patients. Mortality rates were higher in patients who received their transplants for advanced, late stage disease. Most long-term survivors had very good to excellent performance scores.

Dr. Horowitz emphasizes the need for further research into preventing and treating late transplant complications. There have been many changes in the transplant regimens used over the past 25 years. Whether these changes will be effective in reducing long-term complications requires continued follow-up of many patients. She also points out that many of the patients in this study were transplanted for diseases not curable by other therapies. In an editorial accompanying this article, E. Donnall Thomas, M.D., and Nobel Laureate, points out that the slightly increased risk of death over time is better than the alternative afforded by non-transplant therapy.

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