Bone marrow transplants for leukemia and lymphoma are becoming safer, more successful, and more common. Increasing numbers of patients are surviving for years after this procedure, in which healthy bone marrow is transplanted into a person after their diseased marrow has been destroyed by drugs or chemotherapy. Despite improvements, the surgery is still highly invasive and riddled with potential complicationssuch as rejection of the new bone marrow, recurrent infections, and the reappearance of cancer. A new study attempts to measure physical and emotional recovery time for stem-cell transplants, in the hopes that families and their doctors can be better prepared for the effects of this type of treatment.
What the researchers wanted to know: How long does it take people to recover after successful bone marrow transplant surgery?
What they did: The researchers, doctors from the Fred Hutchison Cancer Research Center in Seattle, enrolled 319 stem cell transplant patients and surveyed them before the procedure and after 90 days, one year, three years, and five years. The researchers used tests to measure the physical health of patients, depression level, distress over complications from cancer, and whether patients could return to work. After 5 years, 120 of the original participants were still living, and 99 completed the 5-year follow-up survey.
What they found: Recovery lasted at least one year, and some patients still had not recovered five years after a bone marrow transplant. Physical recovery usually came first, though complications sometimes made that a bumpy road. Most patients experienced at least mild depression, which waned slightly for most people after a year, though 19 percent still reported feeling depressed after five years. Distress and worry about cancer declined at the slowest rate: 79 percent of patients were distressed after a year, declining to 42 percent after three years, and to 13 percent after five years in remission. After five years, 84 percent of cancer survivors in remission had returned to work outside of the home.
What it means to you: Recovery from bone marrow transplants can be a slow and unsteady process. The researchers point out that recovery does not always go in a straight line; for example, 8 percent of patients who were not depressed after a year had developed depression after three years, and a variety of factors can determine recovery rate. In an accompanying editorial, one of the researchers said patients and their families must keep in mind that "transplant is not a process that is over when the patient goes home in three months or even in one year."
Caveats: Because of the severity of the illness these doctors studied, nearly two hirds of the people who began the initial study dropped out, either because of death or recurring cancer, before the five-year follow-up. Though the drop-outs' initial test scores did not differ from those who completed the study, those who did stay healthy for five years may have been a healthier population to begin with and thus more prone to quick recovery. Also, the study data underrepresent certain groups, especially Hispanics and patients who donated their own stem cells for transplant.
Find out more: Information about both leukemia and lymphoma can be found through the National Cancer Institute, which has pages of information about each type of cancer in addition to treatment methods and therapies used to keep the cancer in remission.
The Bone Marrow Transplant Information Network is an excellent website geared toward bone marrow transplant patients and their families.
Read the article: Syrjala, K.L., Langer, S.L., Abrams, J.E., Storer, B., Sanders, J.E., Flowers, M.E.D., Martin, P.J. "Recovery and Long-term Function After Hematopic Cell Transplantation for Leukemia or Lymphoma." Journal of the American Medical Association. May 19, 2004, Vol. 291, No. 19, pp. 2335-2343.
Abstract online: http://jama.ama-assn.org/