What have been the success rates and what are the risks of having a allogeneic hematopoietic cell transplantation (HCT)?

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PaulODonnellMDPhD (Physician - Oncology - Hematology/Oncology (Verified) ) - 07 / 20 / 2012

Success of allogeneic transplantation is measured in disease-free survival (DFS), i.e., absence of relapse of the patient’s disease or of death due either to underlying disease or complications of the transplant procedure. Relapse remains the most significant cause of treatment failure and is the focus of much current research in the field. Death due to transplant complications has declined steadily over the past 2 decades due to improved supportive care. Thus, there is a much lower incidence of infections, organ toxicity and graft-versus-host disease (GvHD), the unwanted side effect of the donor’s immune response which results in attack of normal tissue in addition to cancer cells. GvHD can occur early (usually within 30-60 d) or late (after 3-6 months) after transplant and remains one of the most significant risks of the procedure. GvHD can affect the skin, liver and GI tract of the patient and requires use of drugs which suppress the immune system. Since similar cells of the immune system are involved in the beneficial anti-cancer effect and in GvHD, a delicate balance of immunosuppression is required. GvHD usually can be controlled and the immunosuppressive drugs withdrawn but if it is resistant to control (in about 5% of patients) there can be a fatal outcome. DFS depends on many factors including the particular diagnosis of hematologic malignancy and the stage of the patient’s disease at the time of transplant.
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