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Bone Marrow Transplants a Thing of the Past?

WebMD Health News
Reviewed by Gary D. Vogin, MD

Jan. 17, 2001 -- Although still considered risky, bone marrow transplantation has become one of the standard treatments for a number of serious illnesses, including cancer. But new research suggests another kind of transplant -- using blood cells rather than bone marrow -- might be even more effective for patients suffering from cancers that affect the blood and lymph nodes.

When patients undergo chemotherapy and/or radiation treatment to wipe out their cancer, their healthy cells and bone marrow are often damaged in the process. Doctors then transplant these patients with bone marrow containing healthy stem cells, with the hope that some of them will produce more stem cells while others will grow into mature blood cells.

Although most stem cells are found in the bone marrow, some -- known as peripheral blood stem cells -- are found in the blood. In the Jan. 18 issue of TheNew England Journal of Medicine, researchers report that cancer patients who receive peripheral blood cells do better than those who get bone marrow stem cells.

The patients included in the New England Journal of Medicine study received allogeneic transplants -- that is, transplants donated by another person, in this case, a closely matched relative. Transplants can also be autologous, which is when cells are taken from the patient and stored, and then given back to the patient after chemotherapy.

"In the past decade, the investigators performing autologous stem cell transplants have switched to the use of peripheral blood as the preferred source of stem cells," says Hillard M. Lazarus, MD, professor of medicine at Case Western Reserve University in Cleveland and chairman of the blood and marrow transplant committee of the Eastern Cooperative Oncology Group, one of the largest clinical cancer research organizations in the U.S.

What researchers have found, Lazarus says, is that the bone marrow of patients grows back faster when they get their own blood stem cells than it does when they get their own marrow cells. This leads to fewer treatment-related deaths, shorter hospital stays, and oftentimes, lower costs.

Similarly, reports in recent years have shown allogeneic blood stem cell transplants to be superior to allogeneic bone marrow transplants, says Lazarus, who was not involved in the study but reviewed it for WebMD.

"Our main message is that allogeneic peripheral blood stem cells are an important alternative to marrow as a source of stem cells," says William I. Bensinger, MD, a co-author of the New England Journal of Medicine study. These cells may have certain advantages over marrow in terms of lower rates of complications, death, and disease relapse, adds Bensinger, an associate professor of medicine at the Fred Hutchinson Cancer Research Center in Seattle.

In the study, 172 patients were randomly assigned to receive either bone marrow or peripheral blood stem cells, both from closely matched relatives. The group receiving the blood cells recovered certain important blood components -- the neutrophils and platelets -- significantly faster than the bone marrow group, and they required fewer transfusions of platelets.

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