Let us examine Leukemia and Bone Marrow Transplants (BMT) shall we?
LeukemiaTreatment of leukemia with an autologous BMT is becoming more common. Patients with acute lymphocytic leukemia (ALL) or acute myelogenous leukemia (AML) (also called acute non-lymphocytic leukemia or ANLL) may be candidates for an autologous BMT if their disease is in complete remission. Since a complete remission is rarely achieved in patients with chronic myelogenous leukemia (CML), an autologous BMT is usually not a treatment option for these patients (although some very interesting studies are now underway using ABMTs to treat this disease).
Leukemia is a disease of the bone marrow, the organ that produces the body's blood cells. In patients with leukemia, a large number of abnormal white blood cells are produced in the bone marrow and interfere with the production of normal blood cells. Without normal blood cells, the body's ability to fight infection, carry oxygen to tissues, and prevent bleeding is impaired. Patients with acute leukemia will die within a matter of weeks or months without treatment.
Patients with acute myelogenous leukemia (AML or ANLL) who've achieved a first complete remission with standard chemotherapy may be able to increase their chances for long-term survival significantly with a BMT. Without a BMT, their expected long-term survival rate is 20 to 30 percent.
Researchers are currently studying whether autologous BMTs are more effective than standard chemotherapy in treating patients with AML in first remission. Preliminary results suggest that survival rates do improve with an autologous BMT, but further study is underway to determine whether these improved survival rates are the result of the autologous BMT or other factors such as the type of patients chosen to participate in the study or the sub-type of AML affecting the patient.
BMTs are also performed on patients with acute lymphocytic leukemia. ALL typically strikes children. Because the cure rate with standard chemotherapy is quite high, only a few studies have been conducted to date on the use of BMTs in the treatment of ALL. While the studies have found that both autologous and allogeneic BMTs are an effective treatment option for ALL patients, some experts believe that too little data are currently available to reliably project long-term survival rates.
People are often surprised that an autologous BMT is a treatment option for patients with leukemia. Since it's known that malignant cells may remain in the bone marrow of patients with leukemia even after a complete remission has been achieved, they question why it makes sense to harvest imperfect marrow and re-infuse it back into the patient via an autologous BMT.
Researchers are not sure of the answer, but some theorize that the number of malignant cells re-introduced into the patient is so small that the body's normal defenses can destroy them before they proliferate. Many centers purge the harvested bone marrow to reduce the number of cancerous cells that remain in the sample. For more information on purging see page 30.
PREPARING FOR THE TRANSPLANTA successful transplant requires the patient be healthy enough to undergo the rigors of the transplant procedure. Age, general physical condition, the patient's diagnosis and the stage of the disease are all considered by the physician when determining whether a person should undergo a transplant.
Prior to a bone marrow transplant, a battery of tests is carried out to ensure the patient is physically capable of undergoing a transplant. Tests of the patient's heart, lung, kidney and other vital organ functions are also used to develop a patient "baseline" against which post-transplant tests can be compared to determine if any body functions have been impaired. The pre-transplant tests are usually done on an outpatient basis.
A successful bone marrow transplant requires an expert medical team - doctors, nurses, and other support staff (internet panhandlers saying for years... maybe tomorrow the bankers will pay up so the funds I have "allocated" will pay for her surgery... does not qualify as support staff)- who are experienced in bone marrow transplants, can promptly recognize problems and emerging side effects, and know how to react swiftly and properly if problems do arise. A good bone marrow transplant program will also recognize the importance of providing patients and their families with emotional and psychological support before, during and after the transplant, and will make personal and other support systems readily available to families for this purpose.