Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Blood transplants may be more harmful than bone marrow transplants in pediatric leukemia patients

03.11.2004


Results differ from adult patients, underscore need for more research



A new study has shown for the first time that transplantation of peripheral blood stem cells (PBSC) from sibling donors may be more harmful than bone marrow in pediatric leukemia patients.

Researchers from the International Bone Marrow Transplant Registry (IBMTR) found that patients undergoing PBSC transplants were more likely to die of transplant-related causes than those who underwent bone marrow transplants. It is estimated that nearly 30% of transplants from sibling donors in pediatric patients now use peripheral blood stem cells. The study and an accompanying editorial will be published November 1 in the Journal of Clinical Oncology (JCO).


"Our data support the use of bone marrow for transplantation in these patients when a matched sibling donor is available," said Mary Eapen, MBBS, MS, Assistant Professor at the Medical College of Wisconsin and lead author of the study. "The higher rates of mortality observed after PBSC transplantation compared to bone marrow transplantation should serve as a cautionary note, and underscore the urgent need for a properly designed clinical trial to define the role, if any, of donor peripheral blood stem cell transplantation in children."

Background

Leukemia is cancer of the bone marrow. Bone marrow transplants involve the collection from the donor of "hematopoietic" stem cells - immature cells found in the bone marrow that mature into red blood cells, white blood cells, and platelets. Doctors have traditionally treated children with leukemia using bone marrow donated from a sibling when available, or from an unrelated volunteer donor. Another approach is peripheral blood stem cell (PBSC) transplantation, in which these stem cells are collected from the donor’s blood, rather than directly from their bone marrow.

In both types of transplantation, the patient’s cancerous bone marrow is destroyed with high doses of chemotherapy or radiation. Then bone marrow or peripheral blood stem cells are given to the patient, which replaces the destroyed marrow.

In adults, peripheral blood collection has become increasingly common in recent years, because it allows donors to avoid the difficulties of bone marrow collection, such as surgery and anesthesia. Since peripheral blood transplantation has been shown to be as safe and effective as bone marrow transplantation in adults, some doctors have begun recommending use of peripheral blood transplants in pediatric patients.

Findings

Eapen and her colleagues compared the outcomes of 143 PBSC and 630 bone marrow transplants in patients with acute leukemia aged 8-20 years who were transplanted between 1995 and 2000. This analysis was performed with data reported to the International Bone Marrow Transplant Registry (IBMTR).

Despite faster recovery of blood counts, more patients who underwent PBSC transplantation died as result of transplant-related complications (26%, compared to 14% of bone marrow transplants) - especially chronic graft-versus-host disease, a potentially serious complication in which the transplanted cells attack the tissues of the recipient. Chronic graft-versus-host disease was significantly higher after PBSC transplants than after bone marrow transplants (33% vs. 19%).

Overall mortality was also higher after PBSC transplants - 57%, versus 44% after bone marrow transplants. The risk of leukemia recurrence after transplantation did not differ. These results persisted after controlling for relevant risk factors that may affect outcomes after transplantation. It is important to note that the current study addresses transplants from donors only, not "autologous" PBSC transplants, in which stem cells are taken from the patient’s own blood. This approach has been proven safe among adults and children, and is widely used.

An accompanying editorial by Donna A. Wall, MD, of the Texas Transplant Institute in San Antonio, underscored the need for a prospective study designed to assess PBSC and bone marrow transplantation in pediatric patients. "This is an unsettling finding, given that nearly 30% of transplants from sibling donors in pediatric patients now use peripheral blood grafts," Dr. Wall said. "It very well may be that peripheral blood stem cells do not offer a benefit over bone marrow in pediatric patients. It is critical that this question be carefully studied by prospectively identifying the patients, diseases, and clinical settings in which clinical benefit is likely to be observed. Until then, patients and families need to be informed about the risks of transplant-related morbidity, including chronic graft-versus-host disease and higher risk of mortality."

Danielle Potuto | EurekAlert!
Further information:
http://www.asco.org

More articles from Studies and Analyses:

nachricht New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)

nachricht Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

Im Focus: Quantum-physical Model System

Computer-assisted methods aid Heidelberg physicists in reproducing experiment with ultracold atoms

Two researchers at Heidelberg University have developed a model system that enables a better understanding of the processes in a quantum-physical experiment...

Im Focus: Glacier bacteria’s contribution to carbon cycling

Glaciers might seem rather inhospitable environments. However, they are home to a diverse and vibrant microbial community. It’s becoming increasingly clear that they play a bigger role in the carbon cycle than previously thought.

A new study, now published in the journal Nature Geoscience, shows how microbial communities in melting glaciers contribute to the Earth’s carbon cycle, a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

New quantum liquid crystals may play role in future of computers

21.04.2017 | Physics and Astronomy

A promising target for kidney fibrosis

21.04.2017 | Health and Medicine

Light rays from a supernova bent by the curvature of space-time around a galaxy

21.04.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>