This is an important study. The problem with bone marrow transplants is the high incidence of graft-versus-host-disease. Stanford scientists have now developed a protocol that significantly reduces graft-versus-host-disease after bone marrow transplants with much better survival of patients. Note that bone marrow transplants is one of the ways in which doctors can treat progressive chronic multiple sclerosis and other devastating autoimmune diseases. By replacing the immune system with cells from another person, this would be a solution. However, The high incidence of GVHD and the high morbidity and mortality of the procedure is one of main reason why this treatment cannot be used unless the doctors and patient are truly desperate. I think that this may lower the threshold for the use of bone marrow transplants to treat people with severe progressive multiple sclerosis.

Wise.

http://www.medbroadcast.com/health_n...hannel_id=1000

Doctors develop safer bone marrow transplants to fight cancer

Sep. 29, 2005


Provided by: Canadian Press
Written by: MARILYNN MARCHIONE

(AP) - Doctors seem to have found a way to make bone marrow transplants safer and more effective against blood cancers like leukemia, an achievement that offers new hope for people over 50 in particular.

The advance by Stanford University doctors could make such transplants, which have dramatically improved cancer survival among children and young adults, more widely available to older people who typically don't fare as well.

It also brings the field closer to its Holy Grail - training a recipient's body to accept tissue from another person and live a "blended" life without heavy reliance on anti-rejection drugs.

Scientists already had achieved this in mice; Stanford researchers now have extended it to people. Their study is published in Thursday's New England Journal of Medicine and was funded by the National Institutes of Health.

Specialists said the study was small and preliminary, but very promising.

"If it works, we would be able to do transplants in a lot more people," said Dr. Mary Horowitz, scientific director of the Center for International Blood and Marrow Transplant Research, based at the Medical College of Wisconsin, which had no role in the research.

Ideally, a leukemia or lymphoma patient would be given radiation or high doses of chemotherapy to destroy the cancerous bone marrow before receiving healthy marrow or blood stem cells from a donor. However, many patients, especially those over 50, die of infections they are unable to fight off before the new marrow takes hold and grows.

To avoid this problem, doctors usually destroy only part of the patient's original marrow. That brings other dilemmas: some cancerous blood cells remain, and the new marrow frequently attacks the old - an often-fatal problem called graft-versus-host disease.

Stanford researchers developed a way to condition the recipient to accept the new marrow and to inactivate the parts of the patient's immune system that would attack it. They used a combination of low-dose radiation over two weeks and short courses of immune-suppressing drugs.

Only two of the 37 patients given the experimental treatment developed severe graft-versus-host disease. Ordinarily, more than half of them would have.

An average of one year later, 27 of the 37 were still alive, and cancer was in complete remission in 24 of them - better results than usual. The average age of the patients was 52.