The MDS Beacon™

This article is part of a series about stem cell transplantation in MDS, which will be published over the next couple of weeks. The series will explain the different types of stem cell transplants, describe the procedure for both patient and donor, address benefits and risks, and talk about prognosis and life after the transplant.

Although stem cell transplants can cure MDS, they are associated with certain risks and complications.

This article will summarize the benefits and risks associated with the procedure.

Benefits

A stem cell transplant replaces an MDS patient’s unhealthy bone marrow cells with healthy ones. These healthy bone marrow stem cells can produce functional blood cells that lead to improved blood counts, a longer life, and potentially long-term remission for some MDS patients.

In a recent study, Dutch researchers found that patients under 61 years old who underwent an allogeneic (donor) stem cell transplant lived significantly longer (5.7 years) than those who did not (0.9 years).

According to a study carried out by the European Blood and Marrow Transplantation Group, 39 percent of MDS patients remained alive three years after undergoing a donor stem cell transplant.

Risks

Despite the advances in transplantation technology, stem cell transplants are still considered high-risk procedures due to the related side effects and complications, including transplant-related death.

In addition, the relapse rate after donor stem cell transplants remains high for MDS patients.

According to a study conducted at the Cleveland Clinic with 993 MDS patients who had received a stem cell transplant from a matched sibling, 29 percent died within three years from transplant complications. Relapse occurred in 28 percent of the patients.

Side effects and complications can stem from the preparative chemotherapy before the transplant as well as the procedure itself.

One common side effect patients experience during the preparative therapy is severe nausea and vomiting. Some patients lose considerable amounts of weight or are not able to eat solid foods.

Other common side effects of the preparative therapy include mouth lesions, ulcers, skin rashes, hair loss, and veno-occlusive disease.

Veno-occlusive disease is a condition in which the small blood vessels in the liver are blocked due to the preparative therapy. The liver cannot function properly any more, leading to a buildup of toxins in the liver.

The two to four weeks after a bone marrow stem cell transplant are the most critical during the entire procedure because most of the complications occur during that time period. Patients are closely monitored during that period for any signs of complications.

During the first 30 days after transplant, patients are most vulnerable to excess bleeding and infection.

The preparative therapy inhibits or kills the patient’s own stem cells. As a result, the patient’s blood cells responsible for fighting infection and clotting are at very low levels until the donor’s stem cells engraft and start to grow in the patient.

Patients can receive platelet and red blood cell transfusions if serious bleeding occurs. Antibiotics are prescribed to treat infections.

In addition to bleeding and infection, graft-versus-host disease is one of the most common complications resulting from a donor stem cell transplant.

Graft vs. host disease (GVHD) occurs when the transplanted donor immune cells attack the patient’s body.  This can occur within the first three months after the transplant (acute GVHD) or develop after the first three months following the transplant (chronic GVHD).

Graft-versus-host disease can affect different parts of the body, especially the skin, eyes, mouth, stomach, and intestines. Symptoms include cramps, diarrhea, fever, rash, dry eyes or mouth, and lung and digestive tract disorders.

Finding a closely matched donor and giving the patient drugs that suppress the immune system are important preventive measures.

Despite these preventative techniques, graft-versus-host disease occurs in 30 to 50 percent of patients receiving a donor stem cell transplant.

For more information on life after the transplant and experiences of MDS patients who have received a stem cell transplant, please see the subsequent articles in the series, which will be published over the next few weeks.