Tuesday, July 16, 2013

More older patients receiving stem-cell transplants at KU Cancer Center

By MATT ERICKSON, The Lawrence Journal-World

If Patti Kennicott had gotten her diagnosis 10 years earlier, she would have had only a few months to live, Joseph McGuirk says.

Kennicott, who lives in Ottawa, was 62 when she was diagnosed with acute myeloid leukemia in 2010. Ten years before, conventional wisdom among doctors would have been that she was too old to receive a stem-cell transplant to treat her cancer, and her chance of survival would have been slim.

But Kennicott, now 65, is still alive. She received a stem-cell transplant at the Kansas University Cancer Center’s Blood and Marrow Transplant program in February 2011.

And that’s no longer a rare outcome for someone her age. The KU BMT program now sees more transplant patients in their 60s, and even their 70s or 80s, than ever before, after recent research has shown that stem-cell transplants can indeed be safe for older people.

Things have changed a lot since McGuirk, the medical director for the BMT program, started in his field in the early 1990s.

Back then, he said, the two-year survival rate was about 5 percent for a 70-year-old who received Kennicott’s diagnosis of AML.

“It was terrible, every bit as bad as pancreas cancer,” McGuirk said.

Back then, doctors assumed that the intensive chemotherapy and radiation that accompanied stem-cell transplants would be too much for elderly patients — even though some blood-borne cancers, such as AML, are more common in older people.

But since about 2000, doctors at KU and elsewhere have found that stem-cell transplants were effective in treating those cancers even without those other intensive therapies, using donors’ stronger immune systems to destroy the cancer.

So by the time Kennicott got her diagnosis, transplants for patients 60 and older were commonplace at the KU Cancer Center.

KU is also unusual in that it offers cord blood transplants, a newer technique that uses stem cells from donated umbilical cords, McGuirk said. That can be especially helpful for older patients, who are less likely to have a sibling who can match as a donor.

That’s the kind of transplant Kennicott received in 2011, after unsuccessfully undergoing two types of chemotherapy.

Two years later, she’s healthy. She tends to her flowers, cooks and spends time with her family, with her second great-grandchild on the way shortly.

“I feel fantastic,” Kennicott said.

Now KU Cancer Center doctors routinely perform transplants on people as old as 80, McGuirk said. The oldest patient in the unit this week, he said, was 73.

The KU BMT program, based in Westwood, is growing fast, on pace for about 300 transplants this year after performing fewer than 50 as recently as 2006. And many of those new patients coming in have been older people who wouldn’t have been candidates before, McGuirk said.

He hopes that the increase in older patients will continue, after a study presented at a medical conference earlier this year confirmed that stem-cell transplants are safe for patients 70 or older with blood cancers.

“That was a remarkable milestone for the field,” McGuirk said.

Not all elderly people can safely receive a transplant: People with heart disease or other cancers might be ruled out. And it’s a complex procedure that offers no guarantees — two-year survival rates for elderly AML patients are now around 45 percent, McGuirk said.

Another issue is that many doctors are still unaware that the procedure is a possibility for older patients, so they don’t present it as a possibility.

But as more of them learn that it’s safe, McGuirk said, it will only become more common for older people diagnosed with blood cancers to be able to enjoy their golden years.

“As we do a better job in the transplant community of getting out and educating our colleagues, we’re going to see a big jump in applications for transplantation,” McGuirk said.