when to do BMTs

[Guest guest]

Dr. Furman,

You raised the possibility of an allogenic transplant for a 34 year-old

man enjoying a good remission. Since you've often indicated that

transplants are not something to be entered into lightly because of the

risks, I'm sure in this case you feel a) it's his best chance for long

term survival and his youth is definitely on his side in such a

procedure. Are there ever circumstances where you might recommend a

transplant for an older person in a CR? I know age and overall state

of health enter into a BMT but are there also disease-related factors

you'd be looking at?

-Ellen D.

[Guest guest]

Ellen D.

There are several considerations that go into the decision, including ease of

obtaining remission, etc. My bias is away from transplants for older patients

because the toxicities become much greater and more difficult to deal with than

in younger patients.

Rick Furman, MD

>

> Dr. Furman,

> You raised the possibility of an allogenic transplant for a 34 year-old

> man enjoying a good remission. Since you've often indicated that

> transplants are not something to be entered into lightly because of the

> risks, I'm sure in this case you feel a) it's his best chance for long

> term survival and his youth is definitely on his side in such a

> procedure. Are there ever circumstances where you might recommend a

> transplant for an older person in a CR? I know age and overall state

> of health enter into a BMT but are there also disease-related factors

> you'd be looking at?

> -Ellen D.

>

[Guest guest]

Dr. Furman comment is the view of many other consultants.

I was told by the transplant consultant that people my age did not tolarate the treatment well due to the toxicity, yet at 64 they told me I was on the top 5% of their patients.

I tolarated the preconditioning well and I had some GVHD for a couple of weeks but no many other problems, I personally feel all was due to how well I prepare myself for the job and how healthy I have been throughout my life, though the consultant said it was more my attitude of mind, something I like to debate one day.

Although I believe in mind over matter, I still think the transplant procedure went easy and I had less discomfords than I remember when I was hospitalised last year in August with two infections and the reactivation of the CMV. However having had a reactivation of CMV during the Campath/Methylprednisolone treatment last year, gave the possibility of 50/50 chance to have it reactivated again after the SCT, so we were all prepared for it to happen and was dealt with prompt.

There are risks with everything in life, no just a transplant.

A lady that had a transplant 2 months before me and we became friendly during our meetings, told me that when she was diagnosed of an aggressive type of leukaemia she was told that without a transplant she had 10% chances to survive and with a SCT the mortality rate at The Royal Free was 15-20%, she said her decision was easy with those figures.

One also has to be aware that a transplant might not work.

I went to a Transplanted Patient meeting at The Royal Free and there were two people there that had had two transplants, I felt for younger people there is a better chance if they can have more than one when the first one fails.

It is too early to know if mine SCT has worker or not and if I will need DLI, but so far all look well.

Considering I had read so much about other people's experiences and was expecting all sort of discomfords, I feel I had it easy and would do it all over again if I was presented with the same situation.

regards

Chonette

Chonette dx 10-02 (aged 57)unmutated, CD38 19%, ZAP70 9%,2004 Prednisolone 8 weeks 50 mg. a day,2005 Prednisolone 8 weeks 50 mg.a day, followed bylow doses chlorambucil (2 mg.),2006 Rituximab and low doses chlorambucil (6 mg. a day 14 days on 14 daysoff) 6 rounds,2007 Low doses Rituximab,2007 Fluradabine Lite, HDMP,. Rituximab 200 mg. monthly (5 rounds)Partial Remission, multiple pea size nodes on neck,Started 16 week Campath/HDMP Protocol in June 2008, to follow SCTCMV activation plus two other infections end week 8th of Campath.Hopitalised for 4 weeks. 2 months gap to allow body to recoverDec 2008/Jan 2009 - HDMP to reduce nodes, bone marrow clean - no more Campath neededAdmited to The Royal Free Hospital 15th March, SCT March 24th following Prof. McKinnon's protocol.Feeling well 3 months post transplant with good engraftment