A blood and bone marrow transplant can seem intimidating to a patient. Moffitt's compassionate team is available to provide comprehensive support to our transplant recipients every step of the way. Here Dr. Hany Elmariah from our Bone Marrow Transplant and Cellular Immunotherapy Program addresses some frequent misconceptions about bone marrow transplants for leukemia patients:
Myth 1: The acute myeloid leukemia (AML) is in remission. Can I skip the transplant?
Remission is not a reason to skip the transplant. In general, the treatment for AML starts with chemotherapy to get the disease into remission, which means that the cancer is no longer visible in the bone marrow. However, there still may be AML in the bone marrow that we cannot detect with our testing. In these cases, the AML has a very high chance of relapse, which is when the AML comes back after remission. An allogeneic hematopoietic cell transplant, where we replace the bone marrow of the patient with the bone marrow of a healthy donor, at the time of remission helps prevent relapse and increases the chance of a permanent cure.
Myth 2: I heard I am too old for an allogeneic bone marrow transplant (the type of transplant where someone else's bone marrow is put into my body).
There is no strict age cutoff for eligibility for an allogeneic bone marrow transplant. Conditions that commonly require transplant, like acute myeloid leukemia and myelodysplastic syndrome, typically affect patients who are in their 60s or 70s. Clinical trials have shown that allogeneic transplant in these diseases is beneficial even in patients up to 75 years old. However, our group at Moffitt would also consider a transplant for patients above this age if they are otherwise fit and healthy. In general, age is just one piece of a very complex evaluation to determine if a patient is healthy enough for a transplant.
Myth 3: My doctor is recommending an allogeneic bone marrow transplant for my leukemia. My donor is not a full match so I think maybe I should wait for a matched donor.
It is not recommended that a patient put off a transplant to wait for a full match. Historically, donors were selected by finding a donor whose bone marrow "matches" the patient. This used to be necessary to reduce the risk of certain transplant-related complications such as graft-versus-host disease where the transplant attacks the patient's body. However, technological advances and modern techniques have allowed the use of donors whose bone marrow does not completely match the patient's bone marrow.
Multiple studies have shown that using these types of mismatched donor transplants can now deliver results that are similar to a fully matched donor. In addition, if a fully matched donor is not available initially, it is unlikely that a fully matched donor will be identified at a later time. In these cases, delaying the transplant to wait for a fully matched donor is not likely to be successful. This leukemia also can continue to grow if the transplant is delayed, which lowers the chances that the transplant will be successful. At Moffitt, the primary mismatched donor type we use is a haploidentical or "half-matched" donor that is typically the patient's son/daughter/brother/parent. Approximately 20-30% of the transplant done at Moffitt use this donor type.
Myth 4: I am getting an allogeneic bone marrow transplant for leukemia, but I am hesitant about having to take all these pills for the rest of my life.
When patients undergo an allogeneic bone marrow transplant, there are many medications needed to prevent transplant complications. One of the primary risks is a condition called graft-versus-host disease in which the transplant can attack the body of the patient. Transplant patients must take medications to prevent this complication. These medicines, called immune suppressants, block the transplant from attacking the patient's body. However, they also can increase the risk of infections such as viruses, urine infections, bloodstream infections, pneumonia, etc.
Patients then also must take antimicrobial medications to prevent these infections. While the transplant process does require many medications, the good news is that these medications are intended to be temporary. When the transplant is successful and side effects resolve, the transplant medications are gradually removed. In ideal cases, most of the medications stop in the first six months after the transplant and the rest are stopped around one to two years after the transplant. In ideal cases, the patient is cured of leukemia, stops all of the transplant medications, and is able to return to normal life.
Myth 5: I have leukemia, but I don't want to get an allogeneic bone marrow transplant because I don't want to be sick for the rest of my life.
The safety of allogeneic transplants has improved significantly in recent years. While recovery is variable, many patients return back to normal life within three months to two years after the transplant. Many patients return to work, travel, and exercise, and are able to go back to all of the things they enjoyed before having leukemia.
Myth 6: I have leukemia. My doctor recommended we wait and see how I respond to chemotherapy and then decide to refer me for a transplant evaluation.
The process of arranging a transplant can take two to three months or longer. In general, it is best for patients who might need a transplant to be seen in the transplant clinic as early as possible to start the process. Waiting to pursue a transplant evaluation can cause delays in transplant planning that can sometimes interfere with the success of the transplant.
If you have questions about our approach to blood and bone marrow transplantation or the difference between a stem cell transplant vs. a bone marrow transplant, you can request an appointment with a specialist at Moffitt Cancer Center by calling 1-888-663-3488 or completing a new patient registration form online. A referral is not required.