Hemato-Oncology-5

HEMATO-ONCOLOGY PART-5

Welcome to the fifth part of a series on Hemato-oncology.
Question: Dr. Chiragbhai, thank you for explaining briefly about role of Stem Cell Transplant/Bone Marrow Transplant in field of oncology.

Most of us used to think that transplant is only for advanced and relapsed cases, when there is nothing else left.
It was interesting to note that for Multiple Myeloma it is a standard of care as part of first linetherapy, same for Acute Myeloid Leukemia, adult Acute Lymphoid Leukemia, and others.

Now, what about role of transplant in Benign and Genetic Disorders?
Answer: As we learned last time, that over 70 different diseases can be treated by use of Stem Cell Transplant, as a standard option, wherever available. Majority of these are genetic disorders. Transplant primarily works by providing healthy stem cells from a donor. Adequate immunosuppression is done first to ensure donor cells are not rejected.

Most common benign disorder is Aplastic Anemia. As you are aware, this is a very serious disease, with severe pancytopenia and a high mortality, especially in first few months after diagnosis, generally from sepsis.

So, even though it is technically a “benign” disorder, we all know that survival is frequently less than many cancers.
Of course, it is important to remember that all patients with Aplastic Anemia do not need transplant. Patients with “super severe” category of AA i.e. those with absolute neutrophil count less than 200, are primary candidates. These patients are at extremely high risk of severe septicemia, if their white cell count is not improved fast. If they have a matched sibling donor, Transplant is the best option for these. It is also an important option for those who have failed first line treatment with ATG and cyclosporine.
For children and young adults, below age 20, it is particularly important option. They tolerate transplant better. This is not a first line option for patients over age 40-50 years.

Que: Are there any other benign disorders, which have been treated by Transplant?

Ans: Yes, but they are not generally known, as they are comparatively rare disorders. This includes refractory Pure Red Cell Aplasia, PNH-Paroxysmal Nocturnal Hemoglobinuria, refractory ITP and others.
Also, severe autoimmune disorders have been recently treated by Transplant at few centers in world.
Next time, we will talk about role in Genetic Disorders.
Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496
Diplomate American Board of Oncology and Hematology. Ahmedabad. drchiragashah@gmail.com
Shyam Hem-Onc Clinic. 402 Galaxy, Near Nehrunagar Circle, Ahmedabad.