Research: Risks from bone marrow transplants

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Haematopoietic cell transplantation (HCT) is an emerging therapy for
severe autoimmune diseases (AID). We report data on 368 patients with
AID receiving HCTs in 64 North and South American transplant centers
reported to the Center for International Blood and Marrow Transplant
Research (CIBMTR) from 1996 through 2009. 
Most transplants are
autologous (the transplant is from yourself to yourself) grafts (N=339); allogeneic (transplant from someone else and so carriers a risk of rejection or causing Graft verse Host disease)HCTs (N=29) were mostly in
children. 
The most common indications are multiple sclerosis (MS), systemic sclerosis
(SSC) and systemic lupus erythematous (SLE). Median (the middle) ages at
transplantation are 38 and 25 years for autologous and allogeneic HCT,
respectively. Corresponding times from diagnosis to transplantation are
35 and 24 months. Three-year overall survival after autologous HCT is
86% (95% confidence interval [CI], 81-91%); median follow up of
survivors is 31 months (range, 1-144 months). The most common causes of
death are AID progression, infections and organ failure
. In the
multivariate analysis, risk of death was higher among patients at
centers that performed <5(less than 5)  (relative risk [RR] 3.5, 95% CI 1.1-11.1,
p=0.03) and 5-15 (RR 4.2, 1.5-11.7, p=0.006) autologous HCT compared to
patients at centers that performed >15 (more than fifteen) autologous HCT for AID during
the study period. AID is an emerging indication for HCT in the region.
Collaboration of haematologists and other disease specialists with an
outcomes database is important to better understand optimal patient
selection, impact of prognostic variables, analysis of long term
outcomes, and development of clinical trials.
Bone marrow transplantions is a way to replace your immune system. You destroy the existing immune system with drugs and then transplant bone marrow. This is where white blood cells are made. This is a risky procedure and at one point had about a 5-8% risk of death from the procedure. This has dropped, but this study in the Americas indicate that if you are undergoing this procedure, it is better to have it done where there is experience in performing the technique as there is a 3-4 time more chance of death if you have the procedure done at a centre who have done less than 15 procedures compared to those places that have done more than 15.

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MouseDoctor

5 comments

  • Many people recieving this treatment have been SPMS. It certainly halts relapses but in some treatments alemtuzumab has been used to deplete immune system prior to transplant
    However Progressive MSers still progress.

  • so…reseting and reconstituting one's immune system is not enough to wipe out the disease!!!

    I thought the Australians managed to cure some MSers….

  • MSRC had a blog from a lady named Stella who had a SCT in Nottingham, I think, for aggressive RRMS. She nearly died, and lost some toes due to sepsis I think. I don't know what's happening about her MS now though

  • My best feelings are with Stella…

    But we have a view of what the risks are (well detailed in this article).

    The question is about the benefit.

    I may assume a 4% risk if I understand what HCT/SCT will do to my MS.

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