With transplantation, a procedure that is not without risk, the chances of definitive healing are excellent. The life-saving role of donors is fundamental, says Fabio Ciceri, president of the Italian bone marrow transplant group
chronic myelomonocytic leukemia, the disease diagnosed by the writer Alessandro Baricco, who on the morning of January 22, told in a post on social media what is happening to him is a rare disease and not one of the most difficult to defeat. Like most blood cancers, it generally affects people over 60-65 years of age: every year about 32 thousand Italians fall ill with one of the dozen different subtypes of hematological neoplasms belonging to three large macro-groups, leukemia, lymphoma and myelomas, which can occur in an acute (more severe and aggressive) or chronic form.
How serious is the diagnosis of chronic myelomonocytic leukemia?
Not a particularly aggressive disease, it is usually diagnosed after the age of 60 and the chances of definitive recovery with the transplant are good answers Fabio Ciceri, director of the Hematology and bone marrow transplantation division at the San Raffaele hospital in Milan and president of GITMO, the Italian bone marrow transplant group.
How do you find out you are sick?
Anemia, a sense of great fatigue that does not go away, sometimes even a feeling of abdominal “bulk”, due to the fact that the spleen is enlarged, are the symptoms that generally make us suspicious – explains Ciceri -. As is often the case with blood cancers, the symptoms are mostly vague, not very specific and common to many disorders, even not very serious. therefore it is essential that people do not get scared, but talk to their doctor without wasting too much time: if he deems it appropriate, he will refer the patient to a haematologist specialist or prescribe any in-depth examinations.
And what are the treatments?
The allogeneic transplantation of blood stem cells is the only option that offers the possibility of achieving definitive recovery – says Ciceri -. It is taken into consideration with very specific criteria: young age, generally under 70, for more aggressive forms of disease. Alternatively, we proceed with different types of drugs that today allow you to keep the disease under control for many years, with a good quality of life for the patients.
What do transplant recipients face?
a rather delicate and complex procedure – underlines the expert -: first of all, the so-called “conditioning therapy” is done, that is a rather important chemotherapy that lasts 5 days and has the purpose of completely eliminating the patient’s cancerous cells and space for healthy ones that will then be taken by the donor. a “heavy” chemotherapy because it induces an absolute deficiency of white blood cells and therefore, together with the tumor, also clears the patient’s immune system. For this reason, being devoid of natural immune defenses, the patient lives in a single and protected room. The transplant itself is like any intravenous transfusion. The donor’s stem cells are then expected to take root within about three weeks. That is, the healthy blood cells that arrive from the donor slowly “take root” and multiply in the patient, gradually bringing him back to normal blood values. In all, the average hospital stay of 40 days.
What are the chances of succeeding and what are the risks?
The results of transplantation in this disease today are excellent, with success rates in over 80% of cases. The most feared complication is the “graft versus host disease” (it is called Graft versus host disease or GVHD): in practice an attack on the patient’s organism by the new immune system that is transplanted to him. Rarely lethal, and today it can be prevented and treated with immunosuppressive therapy that is modulated on a case-by-case basis. The greater the compatibility with the donor, the lower the danger of having graft disease towards the host.
The role of the donor is therefore fundamental. How do you find it?
Donors can be family members or volunteers from the international registry. First of all, a compatibility is sought in the family for 100% of cases and if it is not found, it proceeds with the search in the registry, which today offers a compatible donor in 70-80% of cases. But if there is not even here, you go back to the family unit to find a half-compatible donor: brothers, sisters, parents, children, cousins, uncles can all be 50% compatible.
A donor really saves your life …
Yes, for a blood cancer patient it makes a huge difference. There is a great need for donors, especially young ones, because we know that donors under 30 offer the best chance of transplant success. You can register yourself in the register up to 43 years (and donates up to 55): the wider the register, that is, the more people are willing to offer help, the greater the chances that those in need will find a compatible “bidder”. And an easy procedure: a simple blood or saliva sample is done. The “sample” is thus entered in a worldwide database and, if compatible, the person will be contacted for the donation only when a patient needs the transplant. Donating stem cells or bone marrow does not involve any risk for the donor, but a great opportunity for the recipient.
January 22, 2022 (change January 22, 2022 | 15:43)
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