Bone marrow transplants used to be a source of great stress and fear for oncologists and patients alike.
“It used to be 50-75% of people would have long-term immune problems” following a transplant, including the risk of developing graft versus host disease, a life-threatening response in which a person’s body rejected their new bone marrow cells, explains Shernan Holtan, MD, Chief of the Blood and Marrow Transplantation Section at Roswell Park Comprehensive Cancer Center. “Now, the chances of having severe long-term immune problems is around 5%. It used to be that one-year survival after transplant was around 30-50%. Currently, our one-year survival is trending around 90%.”
In this episode of Roswell Park's podcast, Smarter than Cancer, Dr. Holtan explains how transplants are becoming safer at the same time that other therapies for blood-borne cancers, like leukemias, are becoming prominent, including CAR T-cell therapies. That’s changing the conversation patients are having with their doctors about their treatment options.
“Now we have to talk sometimes about what’s really best, transplant versus CAR T,” she says.
Putting patients first also means employing new practices to get them home faster. Dr. Holtan innovated a new process in which transplant patients receive chemotherapy after receiving their new stem cells. This makes the chemotherapy more effective in killing off any remaining cancer cells and giving the new immune cells a better environment in which to rapidly multiple and build a new immune system for the patient. As a result, patients at Roswell Park are now going home to recover within a few weeks of a transplant, instead of having to stay in the hospital for months.
“When people are able to go home, generally they eat better, their muscles are stronger, and overall they’re in better shape, both mentally and physically,” she says.
