The survival rate for bone marrow transplant recipients has risen, thanks to a decrease in complications, new analysis has found.
Writing in the latest edition of the Annals of Internal Medicine, the researchers say that the overall risk of death dropped by 34% between 2003-2007 and 2013-2017.
The analysis was led by Dr George McDonald, an emeritus member at Fred Hutchinson Cancer Research Center in Seattle, USA . He said the overall mortality decrease stems from a sharp decline in deaths caused by transplant-related complications – such as infections and diseases involving the liver, kidneys and lungs – from 30% to 11% over the past 25 years.
“Each of us has been working hard, trying to make our little corner of the problem less severe,” said Dr McDonald. “Cumulatively, those little improvements sum up to big improvements in outcomes. This paper reflects 25 years' worth of clinical research.”
For this study, Dr McDonald and colleagues reviewed the outcomes of 1,148 patients who underwent a transplant at the Seattle Cancer Care Alliance between 2003 and 2007, and compared them with 1,131 patients who had the procedures between 2013 and 2017.
Although the 2013-17 cohort was older and sicker when they had their transplants, they still fared better than the previous group. In absolute terms, the frequency of overall mortality during 2013-2017 was 40%, say the researchers.
Dr McDonald said although the study was a retrospective analysis of previously collected data, the profession could make educated guesses as to the reasons for the improvements. These include:
- improved methods to prevent, detect and treat the viral, fungal, and bacterial infections that threaten immune-compromised transplant patients;
- the use of less-toxic chemotherapy and radiation regimens to prepare patients for transplant, especially for those at high-risk; and
- advances in the prevention of graft-vs-host disease.
Dr Brenda Sandmaier, oncologist and study author, said the next challenge is to prevent cancer relapse.
“Now that we have significantly reduced non-relapse mortality, we have a platform to implement different treatments to prevent relapse or treat early evidence of recurring disease,” she said. “In another 10 years, [the relapse rate] should and will go down.”
McDonald GB, Sandmaier BM, Mielcarek M, Sorror M, Pergam SA, Cheng GS, Hingorani S, Boeckh M, Flowers MD, Lee SJ, Appelbaum FR, Storb R, Martin PJ, Deeg HJ, Schoch G, Gooley TA (2019) “Survival, Nonrelapse Mortality, and Relapse-Related Mortality After Allogeneic Hematopoietic Cell Transplantation: Comparing 2003–2007 Versus 2013–2017 Cohorts”, Annals of Internal Medicine, doi: 10.7326/M19-2936