Utah Doctors Determine 'Good, Bad' Chemo

Utah Doctors Determine 'Good, Bad' Chemo

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Ed Yeates ReportingUtah doctors have found a new way to predict the best candidates, perhaps even the best outcomes for stem cell transplants. It may depend on what chemotherapy drugs you're taking before doctors try harvesting your stem cells.

Some types of chemotherapy drugs may in some way disable the body's ability to mobilize stem cells from bone marrow for harvesting. Dr. Clyde Ford who heads LDS Hospital's oncology division says researchers don't know for sure why these drugs have a bad effect, but there are some theories.

Clyde Ford, M.D., Oncology, LDS Hospital: "It's possible the chemos just kill the stem cells themselves in the bone marrow and decrease their numbers. It's possible the chemotherapies affect the background cells that support stem cells in the bone marrow."

In any case, for patients like 20-year old Kiersten Nelson, knowing whether these drugs have been used will now help physicians know how best to aggressively harvest those cells.

Kiersten was on a different class of chemo drugs, so physicians drew a good inventory of her stem cells. That means a better outcome when she gets the frozen cells transplanted back into her body next week to attack her Hodgkin's Lymphoma. In fact, barring complications, the prognosis after that transplant…

Kiersten Nelson, Cancer Patient: “I shouldn’t have to ever worry about it again. It should be completely clear.”

The Utah study of more than 200 patients showed chemotherapy with drugs containing certain agents seemed to significantly decrease the patients' ability to produce a good inventory of stem cells. And those effects may be long lasting.

Clyde Ford, M.D.: "And we found for these bad classes of drugs there was not evidence of recovery, even patients who had had them several years ago still would not mobilize well."

Based on the study, doctors may now need to modify or change the recipe for certain chemos before and after harvesting a patient's stem cells.

The retrospective study of more than 200 patients recommends that stem-cell rescue patients' exposure to chemotherapy, especially drugs with platinum compounds and alkylating agents -- the two classes found to have the most negative effect on stem cell rescue -- be minimized prior to mobilization of the cells.

Commonly used chemo drugs in these classes include Cisplatinum (platinum analogs), Cyclophoshamide and nitrogen mustard (alkyating agents), Doxorubicin (topooisomerase inhibitors), etc.

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