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Chemotherapy & Bone Marrow Tranplant

Posted by : Dr. B. Padate, 06 Nov 2012 05:17 AM
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Every patient with cancer is different, e.g. the characteristics of cancer like leukaemia, patient’s fitness to receive treatments are different and hence the treatment for each patient is tailor made. The commonest components of treatments are chemotherapy, directed cancer treatments, radiation treatments in some selected patients and stem cell or bone marrow transplantation for some patients, in whom the risk of leukaemia coming back is very high after first line treatment. This is predicted by looking at the patient’s risk factors at diagnosis. 

Chemotherapy is a common word used for cytotoxic which kill cells, in other words, the medicines which are toxic to cells. These medicines are not selective for cancer cells and hence have an effect on normal cells as well, leading to several side effects. While the directed therapies are directed towards cancer cells only and hence have minimum side effects. There are more and more directed therapies being developed. They are used in several combinations with chemotherapy treatment. Radiation therapy is rarely used nowadays for leukaemia but is a useful tool for treating localised solid cancer tumors in other cancers.

In a few patients, cancer comes back after the first treatment and needs stronger treatments. Several times, these patients are not fit for such treatments a second time and cannot tolerate them. To avoid such situations, nowadays at diagnosis we only perform molecular tests to identify the patients as good risk and poor risk, etc. In case of a good risk disease, chemotherapy is likely to be a sufficient treatment and no further treatments are necessary. 

Poor risk patients are identified at diagnosis and the key thing here is to avoid the disease from coming back after first line therapy. To achieve this we perform bone marrow transplantation after the first line therapy. This is curative therapy but a very strong treatment. This approach is adopted worldwide now. In case cancer like leukaemia returns after first line treatment, a bone marrow transplant can be performed to cure the patient if the procedure is tolerable and the patient is fit. Patients are selected carefully for such procedures by weighing the risks and benefits of the procedure. 
       
Bone Marrow Transplantation
There are several types of bone marrow transplantation. The aim of this treatment is to replace the existing abnormal stem cell, which is the source of cancer, by a normal healthy stem cell. Bone marrow transplants can be autologous transplantations where the patient’s stem cells are stored and the patient is given intensive chemotherapy and the stem cells are infused again to allow the remaining healthy stem cells to grow.

The kind of bone marrow transplant used to treat leukaemia is called allogeneic bone marrow transplant. Here a matched donor from the brother or sister or from the international unrelated donor registries is identified and patients are given those healthy stem cells after very strong chemotherapy to get rid of their own cancerous stem cells. This procedure can be very intense and toxic and needs hospital admission for 6 weeks. Later, the patient remains on medicines for a few months more for the new stem cells to grow and become acceptable to his body. 

Other types of stem cell transplantations are where the source of stem cell is cord blood, in other words, the stem cells are taken from the placenta and the umbilical cord after the baby is born. This is potentially a very good source of stem cells. Exceptionally rare stem cells can be taken from the parents where the cells are only half match called haploidentical transplantation. 

The decisions to perform bone marrow transplantation are taken only if such procedure is likely to cure the patient.

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Dr. B. Padate, MBBS MD (Med) MRCP (UK) FRCPath (UK) CCST (UK)