Bone marrow transplants or chemotherapy treatment

Researchers at the Medical College of Wisconsin in Milwaukee and The University of Texas Anderson Cancer Centre have found that patients with the blood cancer chronic lymphocytic leukemia (CLL) had a 26% probability of long term survival when treated with chemotherapy compared to 40% when treated with bone marrow transplant.

While they found a significant difference in treatment outcomes, they did not come to a hard-and-fast conclusion about which is better for all patients. Importantly, they provide significant information to make the decision easier for physicians and patients.

The researchers looked at two groups of patients. One group of 125 patients received a course of chemotherapy at Anderson Cancer Centre for their blood cancer. Another group of 166 patients got a bone marrow transplant (BMT) from a sibling donor with whom they were human leucocyte antigen matched. These data were reported to the International Bone Marrow Transplant Registry at the Medical College.

"The hope with a transplant is to cure the underlying disease," says Christopher Bredeson, assistant professor of medicine at the Medical College. "Chemotherapy, on the other hand, is not a cure. CLL has a long latency period so you can live a long time with it, maintained on chemotherapy, but few patients go into complete remission."

That means the relapse rate in chemotherapy patients is very high, while in the transplant patients it is much lower. That would seem to make a transplant the treatment of choice. But, there is another factor to consider: there is up-front mortality with BMT. Between 20% and 40% of patients die of complications directly related to bone marrow transplant. One of these is graft versus host disease which occurs when the cells from donor bone marrow attack the host cells it considers foreign.

The transplant-related mortality in bone marrow patients in this study decreased rapidly after the first year post-transplant. Doctors hope to bring up-front mortality down with further refinement of the transplant process. But in the meantime, they will have to continue the balancing act in making a decision.