P&S Journal: Fall 1997, Vol.17, No.3
Study Highlights Bone Marrow, Stem Cell Transplants
Breast cancer has become the most common indicator for bone marrow transplant, but some patients have difficulty getting insurance coverage for the transplant because most of the research data are from relatively small studies at single institutions. The purpose of a study at the Autologous Blood and Marrow Transplant Registry at the Medical College of Wisconsin, therefore, was to fill in the knowledge gap and identify new trends in high-dose therapy with autologous hematopoietic stem-cell support--commonly known as a bone marrow transplant. Dr. Karen Antman, the Wu Professor of Medicine and director of the Herbert Irving Comprehensive Cancer Center at Columbia-Presbyterian, was senior author of the study.
In the most comprehensive study to date, researchers identified current trends in breast cancer therapy using self-donated bone marrow or blood-derived stem cells. The procedure, in which the patient's own marrow or blood stem cells are removed, stored, and then returned after high dose chemotherapy, is one of a number of methods for treating breast cancer, says Dr. Antman.
Researchers used data from the registry, which is a voluntary organization of more than 170 transplant institutions in the United States, Canada, Central America, and South America that report data to the statistical center at the registry. The researchers looked at records for 5,886 women who received autotransplants at registry centers between January 1989 and June 1995. They identified the following trends:
Use of blood and marrow transplants for breast cancer increased six-fold during the years of the study. Breast cancer became the most common reason for transplant by 1994.
At the beginning of the study period, 7 percent of transplants were done for localized disease and 93 percent were for metastatic disease. y 1995 that had changed dramatically: About half the transplants were done for local disease and half for metastatic disease.
Transplant results depend largely on the stage of disease. Women with stage II or III disease had better survival rates than women with stage IV (metastatic disease). Women whose cancers were responsive to chemotherapy before the transplant did better after the transplant than women whose cancers did not respond.
The interval between diagnosis and transplant dropped sharply: In 1989 less than 20 percent were done within the first year; that number is now 50 percent. Death rates during the first 100 days have dropped from 20 percent in 1989 to 5 percent.
The study was published in the May issue of the Journal of Clinical Oncology.