A: Not necessarily. It's important to realize that this study's findings are based on a statistical average for a large group of patients with different diseases and disease stages when they had the transplant. The study does not predict how long an individual patient will live.
A: Life expectancy describes how much longer, or to what age, a person at a specific age could be expected to live. It is a mathematical average based on the experience of a specific group of people. The experience of each person in the group affects the average for the entire group. The average for the entire group would be decreased if some people in the group lived for a short time, even though the rest of the group lived much longer.
A: The shorter life expectancy is related to a number of things. The combined effects of the pre-transplant disease, the treatment for that disease before the transplant, and the transplant itself all contribute to the shorter life expectancy. Some of the treatments before a transplant, such as total-body radiation and chemotherapy, are toxic to the body and can contribute to complications such as secondary cancers.
A: We did this study for three reasons:
Until now, no one had examined impacts on life expectancy for a large group of adult and pediatric transplant patients.
The Hutchinson Center is in a unique position to study this population because we have kept track of a large number of patients for a longer period of time than any other institution.
A: Comparing the experience of different groups to the experience of the general population is a standard method for analysis of life expectancy. The general population creates a reference point, so that many different groups can be compared to the same standard. Using the general population as a comparison does not imply that the experience of transplant patients is bad, or worse than expected.
A: Yes. We found that 80 percent of the five-year survivors were alive for an additional 15 years. This result for survival at 20 years after the transplants is very encouraging news.
A: Decreased life expectancy was due to a greater number of deaths at an earlier age in the transplant patient group than in the general population. These deaths were from relapse and new cancers, chronic graft-vs.-host disease and infections, and respiratory and cardiovascular diseases. Relapse was less frequent in patients who had allogeneic transplants than in those who had autologous transplants. In allogeneic transplants, immune cells from the donor help eliminate malignant cells in the recipient.
A: Yes. Results were better for patients who had transplants after 1983, compared to those who had transplants before 1983. Patients with chronic myeloid leukemia, or a non-malignant disease, had better results than those with other diseases.
A: We believe the results would be the same. The study also compared results between the Hutchinson Center and a group of Canadian transplant centers. Survival rates were similar for five-year survivors. Any differences in survival would most likely occur during the first five years. In that respect, recent studies have shown better results at the Center as compared to other centers.
A: Maintain a healthy lifestyle and have regular medical checkups that include cancer screenings. Do not use tobacco products, and use sunscreen or clothing to avoid sun exposure. Get the flu shot every year. Any infections should be treated right away. Patients who are not taking immunosuppressive medications should get their teeth cleaned at regular intervals.
A healthy lifestyle also includes regular exercise. As always, consult your doctor before starting any strenuous physical activity. Contact LTFU at 206-667-4415 if you need assistance with problems that might be related to your transplant.
A: It would make sense to compare groups of patients with the same underlying illness according to whether they had a transplant or not. We already know that for many diseases, the chance of surviving for five years is higher with a transplant than without a transplant. We also know that for patients with acute myeloid leukemia, survival rates after five years are higher with a transplant than without a transplant. We have not yet studied other diseases in the same way because information about long-term survival after treatment without a transplant is not available.