Hospitals traditionally have not offered stem cell transplants to patients older than 60 due to potentially severe complications. But Loyola now offers this treatment to patients in their 60s and early 70s.
“A lot of seniors are taking very good care of themselves. They’re in excellent shape, even running marathons and half-marathons,” said Dr. Patrick Stiff, director of Loyola’s Cardinal Bernardin Cancer Center. “As they potentially could live another 15 or 20 years, we believe they are just as worthy of receiving transplants as people in their teens or 20s.”
The median age of patients who are diagnosed with leukemia is between 65 and 68. For patients older than 60 who have aggressive forms of leukemia and undergo conventional therapy, the five-year survival rate is less than 5 percent.
But six of the first seven plus-60 patients who have undergone umbilical cord blood stem cell transplants at Loyola have survived. “They’re doing much better than we anticipated,” Stiff said.
William Karris of Carol Stream, Il. was 65 when he received a cord blood transplant at Loyola for an aggressive form of chronic lymphocytic leukemia. Without the transplant, Karris was expected to live only about six months. The transplant was successful, and Karris now is in remission more than a year and a half after transplant. The chances of a relapse are less than 2 percent, Stiff said.
Karris now plans to go ahead with a delayed knee-replacement surgery, and then return to work as a Bellwood police officer. “I feel pretty good,” he said.
A stem cell transplant can be a grueling and risky procedure. The patient undergoes high-dose chemotherapy, and sometimes high-dose radiation, to kill cancer cells. The treatment also destroys the patient’s immune system cells. To compensate, the patient receives an infusion of donor stem cells, which develop into healthy immune cells.
In addition to the side effects of chemotherapy and radiation, a patient is at risk for severe infections until the new immune system takes hold. And once established, the new immune system can attack the patient’s own body, a condition called graft-vs.-host disease. In such cases, the patient receives drugs to suppress the immune system, which in turn can increase the risk of infections.
Donor cells can come from a donor’s bone marrow or from a newborn’s umbilical cord blood. Stiff said cord blood transplants are easier on elderly patients than bone marrow transplants. Less than 10 percent of cord blood transplant patients experience significant graft-vs.-host disease, compared with about 50 percent of patients who receive bone marrow transplants.
A disadvantage of cord blood transplants is the relatively small number of stem cells that can be obtained from a newborn’s umbilical cord blood. This can lengthen the time it takes to establish a new immune system in the transplant patient. Loyola is participating in a clinical trial in which cord blood is sent to a laboratory that expands the stem cell population to nearly twice the original number.
“We think this technology has the potential of reducing the misery of patients who receive stem cell transplants and improving their survival,” Stiff said.
Loyola has treated more than 3,000 patients with stem cell transplants, more than any other center in Illinois, and has one of the largest unrelated donor transplant programs in the world. Loyola physicians are currently focusing on umbilical cord blood transplants and have a number of novel therapies available for patients with leukemia, lymphoma and multiple myeloma who otherwise can not find a donor elsewhere.
Loyola has performed more than 90 cord blood transplants, and a new study has shown that a center’s experience is indeed an important factor in patient outcomes. Researchers examined records of 514 cord blood transplant patients in North America and Europe. They found that, 100 days after the transplant, the mortality rate was more than twice as high at centers with limited experience (fewer than 10 transplants). The study is published in the January, 2011 issue of the journal Bone Marrow Transplantation.
Loyola University Medical Center