Center reports transplant improvements

Long-Term Follow-Up

Center reports transplant improvements

When it comes to blood and marrow transplants, the Hutchinson Center is showing better outcomes for patients

Dr. George McDonald intuitively knew that transplant patients overall were doing better than ever, but he didn’t have the data to back it up.

"I knew mortality was down, but I didn’t know by how much," he said.

So he approached his colleague, Dr. Ted Gooley, a clinical statistician, to crunch the data. Both men had collaborated on other studies before, so working together—as well as with many other experts at the Hutchinson Center—to answer complex questions was a welcome task.

They both expected good numbers, but the final results were truly outstanding. In this study, results for patients who had transplantation from 1993 through 1997 were compared with results from 2003 through 2007.

The most important result: The risk of dying during the first 200 days after an allogeneic transplant procedure has fallen by 50 percent over the last decade, and survival is significantly better now.

"Everything we looked at improved a decade after the initial analysis," McDonald said.

McDonald and Gooley conducted a thorough analysis of the Center’s transplants and published their results in a recent edition of the New England Journal of Medicine.

Along with decreased mortality, they also found significant declines in the risks of several complications after transplantation, including severe graft-vs-host-disease, infections caused by viruses, bacteria and fungi, and damage to the lungs, kidney and liver.

"This research and the improved outcomes are the result of a team approach to one of the most complex procedures in medicine," McDonald said.

Medical oncologists and transplantation biologists at the Hutchinson Center are supported in the care of patients by specialists in infectious diseases, pulmonary and critical care medicine, nephrology, gastroenterology and hepatology, and by highly skilled nurses and support staff.

And a statistician such as Gooley is always part of that team.

"The most enjoyable aspect of my job is taking complex ideas and methods and explaining them in ways that anybody can easily understand—and that includes clinicians and patients," Gooley said.

But both McDonald and Gooley put much of the credit for these medical advances on the patients themselves.

"The altruism of patients who sign up for our research protocols is the engine of progress in this field," McDonald said. "Much credit must also go to them, because they allowed us to care for them, and they chose to participate in clinical research."

"Our current patients are standing on the shoulders of 10,000 patients who came before them," he said.

McDonald and Gooley pointed to several changes in clinical practices that were important in reducing risks. Many of these changes resulted from clinical research studies at the Hutchinson.

  • Careful monitoring and dose adjustments of potent chemotherapy drugs used in transplantation to avoid too much or too little treatment
  • Use of less intense pre-transplant drug and radiation conditioning in older patients and in less healthy patients
  • Less use of high-dose systemic immune suppressive drugs to treat acute GVHD
  • Use of the drug ursodiol to prevent liver complications
  • New methods for prevention or early detection of viral and fungal infections
  • Use of better and less toxic anti-fungal drugs to treat serious infections caused by yeast and mold organisms
  • Use of donor blood stem cells instead of bone marrow as the source of donor cells, enabling faster engraftment and return of immunity
  • More accurate matching of marrow or stem cell donors with unrelated patients.

"We try to learn something from every patient who comes through our doors," McDonald said. "This study is a tribute to all of the patients who have signed up for our research studies."