Leading Centers for Low-Dose Bone Marrow Transplants

Extract

Fred Hutchinson Cancer Research Center, Seattle — Seattle transplanters developed the original mini transplant regimen based on years of dog experiments. They deleted up-front chemotherapy, relying instead on low doses of total body irradiation to immunosuppress the patient. Later, they began adding the anti-leukemia and immune-suppressing drug fludarabine (which is now standard with virtually all low-dose protocols). With this regimen, they have achieved high engraftment rates. A paper from the group, which, according to Rainer Storb, M.D., is awaiting publication at a major journal, describes the outcomes of the first 45 patients treated on the Seattle protocol. Storb says that the results for some diseases, particularly chronic myelogenous leukemia, are “spectacular.”

Hadassah University Hospital, Jerusalem — Another pacesetter in low-dose transplants, Shimon Slavin, M.D., published one of the first papers on the subject, which has been cited a whopping 86 times. A report in the May 2000 Bone Marrow Transplantation from Hadassah details the treatment of 23 refractory lymphoma patients. All received intermediate doses of pre-transplant chemotherapy. Disease-free survival at 3 years post-transplant is an encouraging 40%. However, seven patients (30%) died from transplant-related complications, about the same proportion found in conventional transplants.