Baricco and leukemia, when a second transplant can be done and the chances of recovery

He made the announcement a month ago via social media, after the fact and with good news: I had a second transplant, the disease had made a comeback: it was a tough 41 days, but now everything is fantastic. Thus, the writer Alessandro Baricco explained last August 16 that he had to undergo a stem cell transplant for the second time, more than a year and a half after the first (carried out in January 2022), because the leukemia he suffers from has resubmitted. The news made fans tremble, worried about a worsening of his condition: Why did he have to have another transplant?, Can we really have two?, Is there still hope for recovery?, are some of the most recurring questions we have placed at Fabio Ciceridirector of the Division of Hematology and Marrow Transplant at the San Raffaele hospital in Milan, who carried out the writer’s second transplant and is currently treating him.

The first transplant is successful in 80% of cases

First of all, let’s try to understand the reasons for an infrequent occurrence. The neoplasm diagnosed by the playwright, television author and radio-TV host, namely chronic myelomonocytic leukemia, is in fact not particularly aggressive and the chances of definitive recovery with an allogeneic blood stem cell transplant are good: the treatment is successful, on average , in 80% of cases. Baricco is therefore among the least fortunate 20%., but even in this situation there are effective therapies. In patients with this form of leukemia, transplant is the only option that offers the possibility of achieving definitive recovery – explains Ciceri -. a delicate procedure, which involves heavy chemotherapy with the aim of completely eliminating the patient’s cancer cells and making room for healthy ones which will then be infused by the donor. Together with the tumor, however, the chemo also resets the patient’s immune system who must therefore remain in isolation for approximately three weeks, during which they wait for the donor’s stem cells to take root.

When can the second transplant be done?

It may happen that the tumor manages to resist and, over time, there is a relapse. The later it happens the better, because it means that the disease is not very aggressive (Baricco’s first transplant was performed in January 2022 at the Institute for Cancer Research and Treatment in Candiolo, in the province of Turin). Blood values ​​are altered during regular checks (every three, four, six months) and other specific tests can confirm this. What do we do at this point? A second transplant can only be envisaged if they come three criteria are met – replies Ciceri -: if the relapse occurs at least six (better 12 or more) months after the first transplant, if the patient’s condition is very good and if the patient responds to a so-called “rescue” therapy (a heavy mix of chemo and other drugs) which must be able to bring the leukemia back into remission. That is, in practice, the “high” blood values ​​must return to normal. If successful, a different donor is chosen with the hope that it will work better than the first time, always remaining as close as possible to the patient’s family circle.

The chances of recovery

The possibility of recovery still exists, although a further recurrence is always possible, together with the most feared complication of every transplant: graft versus host disease (called Graft versus host disease or GVHD), in practice an attack towards the patient’s body by the new immune system that is transplanted to him. It is rarely lethal and today can be prevented and treated with immunosuppressive therapy that is modulated based on the individual case. The greater the compatibility with the donor, the lower the risk of having graft-versus-host disease. And if the leukemia returns even after the second transplant, what are the prospects? In case of relapse, the disease is always re-evaluated for the possible expression of new mutations that can become a target of targeted therapies, concludes the expert.