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Alert Number 109
Date: July 19, 2024
It may be time to consider stem cell transplants (SCTs) as a good therapy option, as way of actually curing CLL and getting rid of it once and for all, even if you have not exhausted all your other options.
Stem cell transplants come in different flavors: allogeneic “allo” transplants (where your stem cells are replaced with those from a donor), autologous “auto” transplants (where your own stem cells are harvested and given back to you later on), cord-blood transplants (where the stem cells are harvested from cord blood, a by-product of babies). When the donor providing the stem cells is not related to you, it is called a Matched Unrelated Donor transplant, affectionately known as a MUD. Another name for stem cell transplants is bone marrow transplants, since most of the stem cells reside in the bone marrow. They are also called hematopoietic cell transplants or HCTs. Different names for the same thing - don’t let the jargon get to you.
While allo transplants held the promise of a full cure for a percentage of patients who opt for this route, full blown myeloablative stem cell transplants were very aggressive therapy, and until recently carried the penalty of a significant proportion of the patients dying, what I call “death-by-therapy”. For that reason, they were also restricted to patients who met strict age and health / fitness criteria. More recently, “mini” transplants were invented, with much less toxicity and better chances of survival. The big question with mini-transplants was this: are we trading for decreased effectiveness, lower cure rates, by opting for these less strenuous mini transplants? The answer to this one may surprise you.
Stem cell transplants are still evolving. Some of the kinks are being worked out and new approaches being tested. As a patient, you are obviously interested in figuring out your own odds. Are you likely to be one of the lucky ones that gets cured, or are you going to be in the group that does not make it? Should you try a mini, and should you worry you do not have a matched sibling donor and have to depend on the kindness of strangers by going for a MUD?
We review the surprising results reported in two newly published papers from the Hutch, which answer these questions. This is top notch research from one of the best transplant centers, reporting very credible results. You can read our review of these articles in The Only Real Cure Out There, for Now.
Be well,
Chaya
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