Q&A

On Cancer: Memorial Sloan Kettering’s One-Year Survival Rate after Allogeneic Bone Marrow Transplant Exceeds Expectations

By Memorial Sloan Kettering  |  Monday, March 26, 2012
Pictured: Sergio Giralt Sergio Giralt, Adult Bone Marrow Transplantation Service Chief

An independent study conducted by the US National Marrow Donor Program (NMDP) found that Memorial Sloan Kettering Cancer Center significantly exceeded its predicted rate of one-year survival for patients undergoing an allogeneic bone marrow transplantation. The NMDP found that 75 percent of patients undergoing this procedure at Memorial Sloan Kettering survived through the first year. The predicted rate of survival was 62 percent.

In allogeneic bone marrow transplantation, a person's blood-forming stem cells are eliminated and then replaced with new, healthy ones obtained from a donor or from donated umbilical cord blood. The procedure is used as a treatment for certain forms of cancer (including leukemia, lymphoma, multiple myeloma, and myelodysplastic syndrome), as well as other blood disorders.

In an interview, Sergio Giralt, Chief of Memorial Sloan Kettering’s Adult Bone Marrow Transplantation Service, discusses the significance of the findings, and some of the advances that have made transplantation an effective treatment for a growing number of patients.

Why is one-year survival such an important factor for evaluating the effectiveness of allogeneic transplantation?

The first year is critically important because it’s the period when complications of a stem cell transplant are most likely to happen. Before the stem cells are transplanted, a patient undergoes intensive chemotherapy and radiation therapy. In addition to killing diseased cells, this treatment also eliminates the immune system. This leaves the patient at high risk of infection during the first year after transplantation.

Another complication that can occur following an allogeneic transplant is graft-versus-host disease (GVHD). GVHD occurs when the transplanted cells from a bone marrow donor recognize the patient’s own cells as foreign and produce an inflammatory reaction. This can produce a range of serious side effects.

One year after the transplant, patients are typically able to get back to their daily lives with a decreased chance of transplant-associated medical complications.

What do the National Marrow Donor Program findings tell us?

Statistics from the US National Marrow Donor Program (NMDP) compare Memorial Sloan Kettering’s actual one-year outcomes with outcomes predicted by the NMDP, based on many aspects of our patient population including age and the types of disease that we treat.

The NMDP predicted that 62 percent of our patients would survive the first year after a transplant. In our actual results, 75 percent of patients — that’s three out of every four — survived that critical period, and now they’re working toward recovery and becoming long-term transplant survivors.

This is great news for our patients. If you were to receive a transplant at a typical center, your chances of being alive at one year would be 60 percent. When you receive a transplant at Memorial Sloan Kettering, your chance of success is much better than average.

What does Memorial Sloan Kettering do that has led to this improvement in survival after a transplant?

Because patients are at such a high risk of infection, we use very sensitive tests to detect viral infections early. Richard O’Reilly, Chief of Memorial Sloan Kettering’s Pediatric Bone Marrow Transplant Service, has pioneered research that uses donor-specific immune-fighting cells against viruses. This is a new way of treating viral infection in patients who are severely immune compromised.

We’ve also pioneered an approach called T cell depletion therapy, which is a powerful way of preventing graft-versus-host disease. We know that T cells, a type of white blood cells, in the donor graft can cause GVHD. By removing those T cells from the donor’s cells before a patient receives the transplant, we can significantly reduce the occurrence of graft-versus-host disease.

In allogeneic transplantation, it’s important to find a donor whose cells are a good match to a patient’s. Are there any options for people who cannot find a match?

The ideal donor for someone who needs an allogeneic stem cell transplant is a sibling. When it is not possible to find a good match within a patient’s family, we look to bone marrow registries to find another donor whose profile matches the patient’s closely.

When you receive a transplant at Memorial Sloan Kettering, your chance of success is much better than average.

-Sergio Giralt, Adult Bone Marrow Transplantation Service Chief

Because family size is getting smaller in North America, it is becoming more challenging to find suitable donors within a patient’s family. And, unfortunately, volunteer donors from mixed ethnic or minority backgrounds are not well represented in national registries.

Another approach for patients who need an allogeneic transplant is to use stem cells from donated umbilical cord blood. Cord blood has a much lower risk of causing graft-versus-host disease, and can be transplanted successfully in many patients.

Juliet Barker, one of our transplantation experts at Memorial Sloan Kettering, has been a leader in improving cord blood transplantation. Her results are among the very best in the world, and she’s developed a number of new approaches. This means that in our clinical trials, we can often offer unique stem cell transplantation techniques for patients who do not have a donor in their family or in the volunteer registries.

How else do staff at Memorial Sloan Kettering support patients through the challenges of that first year?

What many patients notice when they receive a transplant at Memorial Sloan Kettering is our team approach. Everyone here cares for patients undergoing transplantation in the same way, so it doesn’t matter who your attending physician is or who your nurse practitioner is — you will receive the same expert care.

Our doctors and nurses are also committed to managing patients’ symptoms. We want patients to feel as healthy as possible throughout the procedure, both physically and psychologically. Our social workers, psychologists, and psychiatrists are available to make this as easy as possible, both for our patients and their family members.

In everything we do, we are focused on our patients, and we are relentless in our dedication to getting them back to health.

Comments

I need help, helping my brother. He has multiple myeloma.

If your brother would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225. Thanks for your comment!

My mother may have CLL and lives in Florida near Tampa. Do you have any offices in Florida or can you recommend facility in Florida that has the best care and outcomes.

We do not have any locations in Florida. You can see a list of National Cancer Institute-designated cancer centers here: http://www.cancer.gov/researchandfunding/extramural/cancercenters/find-a-cancer-center. Thanks for your comment!

I understood that allogeneic bone marrow transplant was for hematic neoplasias which had invaded or originated in the bone marrow proper. Can it be done in relapsed non-hodgkin lymphoma?. Or, in these cases, is it only possible the autologous BM transplant?

We are unable to answer specific treatment-related questions on the blog, but you can read more about our treatment approach in our guide to non-Hodgkin lymphoma. Thanks for your comment!

My son has recieved a transplant from his brother in August 2012. What is the prognosis and how many transplants can he have?

Thanks for your comment! However, we're unable to answer specific medical questions on our blog. Please discuss these questions with your son's physician.

What factors determine whether cord blood or unrelated donor transplant is most likely to produce a successful outcome?

Thank you for your comment! Dr. Giralt says that outcomes depend on a variety of factors, including the person's type and stage of disease, the person's age and other medical problems, the level of match of the donor, and other transplant characteristics.

A Stage 3 Multiple Myeloma patient has exhausted treatment options. At age 50, she has been screened and approved for a stem cell transplant. Is an autologous stem cell transplant considered "standard of care" for this patient? Are there situations when an allogenic transplant might be considered an option for this patient .

Thanks for your comment. Unfortunately, we can't answer questions about specific medical cases on the blog. If you'd like to make an appointment with our Physician Referral Service, please call 800-525-2225.

im 54 yrs old. Diagnosed with aml on 6/10/12. Went through the consoladation chemo and after 4 weeks my biopsy was clean. Just finished my 2nd round of maint. chemo and all is well. Im healthy, im in the intermediate risk, my sister is a match.Question,my doctors say a transplant is optional.I think its to risky.Is it exceptable to continue the chemo treatments?

Thanks for your comment. Unfortunately, we can't answer questions about specific medical cases on the blog. If you'd like to make an appointment with our Physician Referral Service, please call 800-525-2225.

would you look first at cord blood from a grandchild for a match for a transplant?

Thanks for your comment! Dr. Giralt says that it's not likely that this would be the case, but your health care provider can give you more information about the particular medical situation.

My bone marrow transplant was on 10/2/2009. I am very greatful for the excellent care I received at Sloane. I am healthy and full of life. Thank you so much and keep up the good work. I recommend this Hospital to every one!

I am a NHL patient.....diagnosed in 1998.....in the process of going into Sloan for Auto stem cell transplant this month....very nervous....had a 9 yr remission period after R-CHOP back in 2002...my lymphoma has transformed into a large B cell follicular lymphoma recently....had R-ICE recently, along with radiation...next step is transplant.....would love to hear some positive feedback from people that have gone thru this and were successful, and could share there experience with me....518 469 8169....thanks, Brian

Thank you for your comment, Brian. You may also want to contact our Patient-to-Patient Support Program http://www.mskcc.org/cancer-care/counseling-support/patient-patient-support, which provides current Memorial Sloan-Kettering patients and their families a chance to speak with former patients.

one one my very close friend diagnosed as cancer in december 2011 now doctors advice her for bone marrow transplant
so weather it possible to take the appointment with u . i am from india

Prashant, you can find information for international patients on our website here: http://www.mskcc.org/cancer-care/international-patients. Thanks for your comment!

I need help completing the screen to be a donor for my brother. We were sent the packet from Martin Fleisher, Ph.D at Sloan; however I need the MSKCC Histocompatibility Testing Requisition form. Can someone from Sloan please send this form to me via email? Thank you!

Dr. Fleisher said that you must get the requisition from the patients doctor, which includes specific HLA ordering information. Thanks for your comment!

My husband has myleofibrosis- he is age 56 -has been on Jakafi- tolerating it well except for anemia ( HGB 8.5)- platelets OK. Is a stem cell transplant our only hope for long term survival? Any chance this can be managed as a chronic disease?

Thank you for your comment. We are unable to answer personal medical questions on our blog. To make an appointment with a Memorial Sloan-Kettering physician, please call 800-525-2225.

My husband is 73 and was recently diagnosed with Ph* ALL. He is taking dasatinib and prednasone and appears to be responding well. Is a stem cell transplant his only next alternative, assuming he will reach CR in this induction stage?

Dolly, we are unable to answer personal medical questions on our blog. If you'd like to make an appointment to speak with a Memorial Sloan-Kettering doctor, you can call 800-525-225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

What is the one year survival rate for patients undergoing an autologus marrow transplant at Sloan?

Hi, Mark. In 2011, the one-year survival rate for adult patients undergoing autologous transplants was 92 percent (172 total adult patients). In 2010, it was 91 percent (178 total adult patients). For pediatric patients, the survival rate was 100 percent (5 patients in 2011 and 7 in 2010). Thank you for your comment.

My sister is 35 years and she diagnose in Jan 2013 ALL Cancer what is survival and success for half match bone marrow transplant.

Amber, we are not able to answer individual medical questions on our blog. If your sister would like to make an appointment to speak with a doctor at Memorial Sloan-Kettering, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

My 82 year brother in law is hosptialized in Hackensack, New Jersey Hospital. Due to complications of his multiple myeloma, he had 12 inches of colon surgically removed approx. 3 weeks ago. Since surgery he has had many other complications due to multiple myeloma. His lung(s) collapsed which required chest tubes, Several days ago he developed pneumonia. He was fed through a tube for a while. Then he had regular meals. He doesn't lilke the hospital food. He is very weak, has sat in a bedside chair, but unable to walk post operatively. He always feels cold, esp. his lower extremities, his feet. He had large amount of fluids mechanically removed from his body. He received five transfusions during the past year. I don't believe he had any bone marrow transplants. His wife, my sister, said her husband is not a candidate for a stem cell procedure as he is 82 years old. I don't know if this is absolutely true, or a regular conclusion at Sloan Kettering? If the family makes a sizeable donation to a medical center, is it possible that he may be re considered for a stem cell procedure. Within the past three days, he developed fluids in his gall bladder and may receive a tube for mechanical removal of the GB fluid(s). He is a mild mannered easy going type of guy; however, he has been discouraged and depressed during this difficult time. His wife and two children discussed bringing him home and having hospice care for him. Initially, during the hospitalization, he was put on a respirator and put into an induced coma to prevent his pulling out the tubes. At that time he begged to go home just one more time. I am a registered nurse who trained at Cook County Hospital, Chicago, in the 1960's. I worked in nursing, hospitals, nursing homes, etc. for nearly twenty years. His wife is also an R,N, who trained at Michael Reese Hopsital in Chicago in the 1950's. One of my classmates is a internist who worked in the ER at the Veterans Adminsiitration Hosp. in EAst Orange. She said that if a doctor had CA, they would go to Sloan Kettering. According to Sloan Kettering protocol for multiple myeloma, and from is written and commented on here, is there any recourse for my brother in law other than what has been indicated in these remarks? I strongly believe to stay strong and to not give up hope in medical conditions.
However, thus far, my brother in law's treatment did not enhance his quality of life at all. Can you suggest or recommend some other avenues of treatment for his multiple myeloma. He has received the Velcade abdominally and not intraveneously prior to his current hospitalzation at Hackesack Hosp. He may be an Army veteran. He was diagnosed with multiple myeloma somewhere between five to eight years ago. He worked as a chemical engineer all of his working years after the army and a degree from IIT in Chicago. Is there any ray of hope in continuing medical treatment for his multiple myeloma, and not resorting to only hospice care. Of course, all of the details, medical records, tests and treatment are included here. So understand if you would say more information is needed, and that the patient would need to be see at Sloan Kettering first before proceeding with any possible, new medical treatment. Sorry if I wrote too much and for too long. Can you please respond to this comment? Thank you very much for your consideration and your help. Sincerely, Mary Alder

Hi, Mary, we are not able to answer personal medical questions on our blog. If your brother-in-law would like to speak to someone at Memorial Sloan-Kettering about making an appointment for treatment or a second opinion, the number to call is 800-525-2225. You can go to http://www.mskcc.org/cancer-care/appointment for more information. Thank you for your comment.

Regarding above remarks, a work was omitted in the statement: "All of the details, medical records, tests and treatments" the word NOT was inadvertrently omitted. The statement should include the word NOT and read, All of the details, medical records and treatment ARE NOT included here.
Sorry for the initial omission of the word NOT, but it is corrected here.
Thank you again very much. CAn you please reply to these remarks.
Sincerely, Mary Alder

i have a baby he is 2 years old.and he is a patient of major thalasemia .i dont know what can i do ,plz help me... i dont want blood transfusion

Hi, Qandeel, if you would like to speak to someone in our Department of Pediatrics about bringing your baby here for treatment, you can call 212-639-5954 or go to http://www.mskcc.org/pediatrics for more information. Thank you for your comment.

What are your pre and post-cord blood stem cell transplant precautionary/isolation measures to protect a patient from viral infections such as parainfluenza lll while in the hospital? Please be specific regarding patient placement near known infected patients and use of common patient areas such as hallways. Please include your visitation policy. Thank you.

Hi, Jo-Anne, we forwarded your questions to Dr. Giralt. He said, "We currently house all our transplant patients in private rooms. Patients with parainfluenza or other respiratory infections are on droplet precautions and are not allowed to leave their rooms. All transplant patients can walk the halls as long as their neutrophil count is over 1000." Thank you for your comment.

My 72 yr old father was recently diagnosed with AML and has been treated with Vidaza once every 4 weeks with Vidaza. We'll be meeting soon with his doctors to discuss a possible bone marrow transplant, the risks, and prognosis. What is the average survival rate and risks? Does bone marrow transplant work well for AML patients?

Stephanie, unfortunately we are not able to answer personal medical questions on our blog. If you would like to speak with one of our doctors, you can go to http://www.mskcc.org/cancer-care/appointment to learn more about making an appointment or call 800-525-2225 during the week to speak to one of our Physician Referral specialists. You might also want to contact the National Cancer Institute's Cancer Information Service at 800-4CANCER or go to http://www.cancer.gov/aboutnci/cis to learn more about treatment for AML. Thank you for your comment.

i have all leukemia,relapsed and my dr. says i need a bone marrow transplant but i am half lebanese and half korean so my chances of finding a match is probably slim my sister matches me but only 50% what r my chances if i decide to use her bm.does it depend on how good the hospital is in doing this procedure or should i look into cord blood transplant.i am 19 1/2 yrs. old

Hasan, unfortunately, we are unable to answer specific medical questions on our blog. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment.
You might contact the National Marrow Donor Program at http://bethematch.org/Home.aspx or call (800) MARROW2 (1-800-627-7692)
You also can call the National Cancer Institute’s Cancer Information Service at 800-4CANCER (800-422-6237).

Thanks for your comment.

I was wondering my husband was suppose to get a stem cell transplant in August he harvested the cells and underwent the ice treatment to get him in remission however they found he has hemochromatosis which is causing high iron in the liver they stopped the transplant now his T-Cell lymphoma is coming back I would like your opinion on whether or not he can get the transplant we are running out of time our only hope is the stem cell transplant he is using his own cells is there a risk of damage to the liver even more I don't know where to turn anymore he has been dealing with this recurring for two years now

Susan, unfortunately we are not able to answer personal medical questions on our blog. If you would like to make an appointment to speak with a Memorial Sloan-Kettering doctor, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information. Thank you for your comment.

My daughter of 12 is getting ready for allogenic transplant with her elder sister's marrow (10/10 match on tests done in New york )
When she was 9 she got hodgkins lymphoma stage 3b with mediastial mass of 10.2 cms..nodes all over neck and abdomen..(tumour load was very high)and got ABVD. She ..had an excellent response and was in CR. After 5 months she relapsed with B symptoms and then went for ICE followed by ASCT in oct 2012. Relapsed again in december 2012 with superclavicular nodes and was on bendamustine (6 cycles) followed by lenalidomide..from august...Now she relapsed yet again in november 2013..with nodes on neck and abdomen..Now planning for IGeV 2 cycles followed by Allogenic transplant from her sisters cells.
My query to you at this stage is if i bring her all the way to memorial sloan kettering from apollo hospitals india ,do u think her chances would be better with all new techniologies u have mentioned ?? what would be the costs for an allo transplant with all associated charges??

Thank you.
Vinod pillai

Vinod, unfortunately we are unable to answer personal medical questions on this blog. If you are interested in speaking to someone at Memorial Sloan-Kettering about an appointment, please contact our International Center at (1-212-639-4900) or go to http://www.mskcc.org/cancer-care/international-patients. Thank you for your comment.

I heard about Dr. Giralt from a patient of his. I found the web page very helpful. How long does it take to get an appointment? thanks!

Insan, thank you for your comment. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. If you live outside the United States you can contact our International Center at 1-212-639-4900 or go to http://www.mskcc.org/cancer-care/international-patients.

My mom was diagnosed in May of 2013 with MDS. She will be 84 in April and was wondering the age of the oldest patient at MSK who had received a transplant and what was the outcome. I know in the past patients were not considered candidates due to the age and other medical issues but I had read that this was changing. My mom was on Vidaza but it seems to have possibly stopped working. Thank you for any information you can provide.

Rachel, you are correct in that older patients sometimes receive transplants--our physicians make decisions on a case-by-case basis. If you would like to make an appointment with a Memorial Sloan-Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

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