Patients with aggressive non Hodgkin's lymphoma don't necessarily benefit from bone marrow transplant (BMT), a new study shows.
Instead, they appear to do just as well when given standard chemotherapy as when given a high dose regime and BMT.
The finding is based on a study of 200 patients who were randomised to either standard chemotherapy or a more aggressive high dose regime followed by BMT. At follow up at 53 months, 61 per cent of the patients who received BMT were free from disease progression and 68 per cent were still alive. However, in the standard treatment group, 56 per cent were free from disease progression and 77 per cent were still alive.
Aggressive approaches to NHL, argue the researchers, should not be the first line in treatment, but reserved for those patients whose disease has failed to respond to less aggressive approaches (J Nat Cancer Inst, 2001; 93: 4-5, 22-30).
BMT is increasingly used to treat a wide variety of cancers. Apart from being of questionable value, it can also lead to acute kidney failure, as documented in a recent review.
Of those undergoing BMT, 5-15 per cent may develop acute kidney failure and, among long term survivors, 5-20 per cent will develop chronic kidney failure.
The reasons why BMT is associated with such poor outcomes have to do with the way a patient is prepared for the procedure. Usually this involves pre transplantation high dose chemotherapy and 'conditioning' with total body irradiation. Such procedures deplete the body of helpful leucocytes, leaving it open to serious infection. Often, renal failure is evident within the first 30 days after a transplant (Lancet, 2001; 357: 6-7).