Wednesday, October 1, 2008

CML - Gleevec or a take a chance on a transplant?

“The brick walls are not there to keep us out. The brick walls are there to give us a chance to show how badly we want something. Because the brick walls are there to stop the people who don’t want it badly enough. They’re there to stop the other people.”

Randy Pausch

And so it goes for cancer patients, especially those facing a transplant, which can wipe out 20% of patients from infections and treatment related mortality alone. New improved treatments over the years have increased overall survival, but not so much the severity of the regimens.

Which led me to wonder what will happen for patients with chronic myeloid/myelogenous leukemia (CML) patients who have done well on tyrosine kinase inhibitors such as Gleevec, Sprycel or Tasigna. The goal of treatment over the last few years has clearly been to achieve at least a major and possibly even a complete cytogenetic response. Compared to a stem cell transplant though, few have achieved a molecular remission, still less maintained it. These patients are in a twilight zone of chronic stable therapy, living largely a normal life, but unlikely to be cured. Stopping vital therapy may lead to relapse rather than the hoped for remission.

And so that brought me to wonder if some of these patients with a good performance status and under 50 years of age might benefit from a transplant given their cancer burden and hematologic status would be much improved over when they were first diagnosed. The chances of surviving the transplant would probably be much improved. Perhaps it is time to consider this idea, after all, the more patients cured from cancer the better.

A transplant wouldn't be suitable for everyone, but for some CML patients, it could be a life saver.

What would you do if it was you or a family member?

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