Tuesday, April 12, 2016

Reduced -Intensity Allo Transplant

Stem Cell Transplants are an option for Follicular Lymphoma, though one that scares a lot of people. Some research from the Annals of Oncology might make All STCs just a little bit less scary.

The article is called "Reduced intensity allogeneic stem cell transplantation for follicular lymphoma relapsing after an autologous transplant achieves durable long term disease control: An analysis from the Lymphoma Working Party of the EBMT."

(Before I go on, I need to comment on the Lymphoma Working Party, which is actually one of seven groups that policies for the European Society for Blood and Marrow Transplantation. But the name sounds like the LWP is a small political party that hopes to win just enough seats in a parliament that they could be asked to join a coalition and maybe get a minor cabinet ministry post for its troubles. For the record, if there was ever a political party made up of lymphoma patients, I would absolutely join it. Our slogan: "Lymphoma Working Party -- Because Politics Is In Our Blood!")

Anyway, that Annuls of Oncology article:

Stem Cell Transplants can be an effective option for Follicular Lymphoma. To put it simply: with an STC, the patient is given an aggressive treatment that basically wipes out her immune system (along with the cancer cells). Immune cells are then put back into the patient to replace it. There are two types of transplants. The first is an Autologous STC (or Auto STC), where the patient's own immune cells are removed before the aggressive treatment, and then put back afterwards. The second is an Allogeneic STC (or Allo STC), where a donor's cells are collected and then put into the patient after the aggressive treatment. Allo STCs have (at least) two big dangers: while the immune system is being replaced, there is a risk of infection, and no way to fight it off. Also, there is the chance that the patient's body will reject those foreign cells (this is known as Host Versus Graft Disease). With an Auto STC, there is no danger of rejecting the cells, since they are from the patient. But there is the danger that those cells going back in might not have been completely clean of cancer. Plus, there's that same danger of infection.

That's the very simple explanation. Read more about Stem Cell Transplants at Lymphomation.org.

It's definitely an aggressive treatment. The patient needs to be pretty healthy to handle that aggression. For patients who may not be able to handle such an aggressive treatment (because of age or poor health), there is the option of a Reduced-Intensity STC. The aggressive treatment that wipes out the immune system is a little bit less aggressive -- still enough to clear out most cancer cells, but not all of them. The donor immune cells might be able to clear out the rest.

The idea of a Reduced-Intensity Allo STC is fairly new -- new enough that not a lot of study has been done on it. This article tries to fix that.

The study looks at 183 patients who had a Reduced-Intensity Allo STC after having an Auto STC that failed. The results were pretty good -- the Overall Survival after 2 years was 63.3%, and after 5 years it was 51.1%. Given where these patients were -- they were close to running out of options -- those numbers are strong.

(The link above is for the abstract of the Annuls article. Healio's report on the study gives a lot more detailed statistical breakdown of the patients and the results, in case you're interested.)

The bottom line here is that the Reduced-Intensity STC has been shown to be an effective strategy for many patients. It's not right for everyone -- the more aggressive standard Allo STC will probbaly continue to be recommended for patients who are healthy enough, and who could benefit from an STC. But it will be interesting to see if the Reduced Intensity option becomes more commonly used for both sets of patients (those who are not healthy enough for an Allo STC, but maybe those who are, too).

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