Quality of Life, Outcomes After Stem Cell or Bone Marrow Transplant May Be Similar Regardless of Patient’s Relation to Donor

Institution Partners | Cancer Centers | <b>Cleveland Clinic</b>

Patients with cancer who receive bone marrow or stem cells from either a related or unrelated donor may experience similar outcomes and quality of life post transplant, which may highlight the efforts made by teams to help patients along the way.

Patients who underwent either a bone marrow or stem cell transplantation from a donor who is directly related to the patient (ie, mom, dad or child) had similar quality of life and overall survival as those who underwent transplantation with a matched-related or matched-unrelated donor, according to recent study findings.

Researchers from this study, which was published in Transplantation and Cellular Therapy, highlight the importance of quality of life when discussing treatment options in patients.

“When we go over with patients and caregivers what to expect after transplant, not only the transplant outcomes are important to discuss, but we also talk about what to expect in terms of quality of life,” said Dr. Sanghee Hong, senior fellow of hematology and oncology at Case Western Reserve University/University Hospitals Cleveland Medical Center, in an interview with CURE®. “There really has not been a study that systematically looked at this to be able to explain to patients and caregivers in terms of what to expect.”

CURE® also spoke with Dr. Ronald M. Sobecks, a professor of medicine and a quality improvement officer of the Bone Marrow Transplant at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, who worked alongside Hong on the study.

“Like many people, when you look at transplant outcomes, the first thing (patients) want to do is get cured, which is great,” he said. “And you want to prevent your disease from relapsing, but if your quality of life is abysmal because you’re carrying severe graft versus host (disease), you have nausea all the time, upset stomach, diarrhea chronically, (you) have to live on meds and you can’t do anything that you used to do before transplant, then the quality of life, you get rid of one problem for another. Now, there’s much better treatments for graft versus host disease than there used to be, and it’s (lower) incidence than there used to be.”

In this study, Hong, Sobecks and their team compared quality of life in patients who underwent hematopoietic cell transplantation with haploidentical donor grafts (90 patients) compared with those who underwent transplantation with other donor sources either related (102 patients) or unrelated to the patient (229 patients).

“Haploidentical transplants really became a well-established alternative donor transplant for people who didn’t have a match-related or matched-unrelated donor for an allogenic bone marrow or blood stem cell transplantation,” Sobecks explained. “This has been a very commonly used approach for many years. The novel thing about this is just that no one’s really formally compared quality of life outcomes using the traditional tools that we use for quality of life for transplant patients comparing it to match-related or unrelated donors.”

In particular, researchers used the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) scale to assess quality of life before transplant, at least 100 days after transplant and at least 180 days after transplant.

“There are four ways that we look at the quality of life, and then with (FACT-BMT), we look at (bone marrow transplant) specific ones,” Hong explained. “Those are the physical wellbeing, social wellbeing, emotional wellbeing and functional wellbeing. And then there are specific (bone marrow transplant)-related questions for those symptoms for the patients to address (bone marrow transplant)-specific issues.”

Results from this study demonstrated that quality of life and other transplant outcomes were similar regardless of the type of transplant a patient underwent. In addition, researchers observed that patients who underwent haploidentical transplants had a higher incidence of non-cytomegalovirus infections.

Those who underwent reduced intensity conditioning (using less of a particular treatment than the standard regimen) haploidentical transplantation had significant better functional and emotional wellbeing compared with patients who underwent matched-unrelated donor transplantation. Patients in the reduced intensity conditioning haploidentical transplant group had higher incidences of relapse mortality and non-cytomegalovirus infections, and a lower rate of non-relapse mortality.

“I think we’re seeing the improvements in quality of life not just because of transplant techniques, but perhaps that there are people who are dedicated to help patients and caregivers go through the transplant afterwards such as social workers and many of the transplant team members,” Hong concluded. “It’s really reflecting our team’s approach in terms of how we can help (patients) get through the process.”

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