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    Bone Marrow Transplants

    High-dose chemotherapy and bone marrow transplant (HDC/BMT) was a treatment regimen for metastatic breast cancer, and later high-risk breast cancer, that was considered promising during the 1980s and 1990s.

    A combination of bad science and poor outcomes finally ended the practice.

    This article is from 2000 and archived here -- if only to urge for better reserach on the part of patients in their own fight against breast cancer:


    This is the most controversial form of conventional treatment for breast cancer. Powerful and painful with severe side effects, bone marrow transplants (BMT) with high dose chemotherapy is a last resort that most physicians and insurance companies regard as a risk not worth taking. Patients, desperate for a way to stop the march of cancer, are often eager to take the risk. About 30,000 women with breast cancer have undergone the procedure.

    Some cancers do respond to the combination of high doses of toxic chemicals followed by repair to the bone marrow. What the breast cancer community and insurance companies want to know is whether these painful and expensive procedures, produce better results than other less invasive and more affordable breast cancer treatment options.

    Most studies of the high dose chemotherapy regimen involved with BMT found that the "no evidence of disease" (NED) and survival rates for this procedure were worse than with traditional drug and radiation treatments. Why go through dangerous bone marrow transplants and extremely toxic chemotherapy, when changing to a different drug produced better results?

    Treatments for breast cancer sometimes make tumors resistant. Higher doses can kill the cancer cells, but destroy the bone marrow - necessary for normal functioning of the immune system. Before high dose chemotherapy, bone marrow from the patient is removed and frozen. After the chemo is finished the bone marrow is replaced. This is called autologous bone marrow transplant. If the bone marrow is from a donor, not the patient, it is an allogenic transplant. Another method is a peripheral blood stem cell transplant. "Stem cells" are immature blood cells removed by filtering the patient's blood, treated to remove any cancer cells and frozen. When the stem cells are replaced after the high dose chemo, they restart the production of blood cells and restore immune function.

    The results from BMT studies were negative until Dr.W.R. Bezwoda from the University of Witwatersrand, South Africa, one of five studies reviewed at the 1999 American Society of Clinical Oncologists Conference, reported a 5 year 17% mortality rate for the bone marrow transplant group compared with a 35% mortality rate for more traditional treatment.

    Physicians, patients and the media, eager to find a means to tackle difficult to treat, late stage, or drug resistant breast cancers and metastases, greeted the news with relief. Based on Bezwoda's results, many doctors began recommending BMT and insurance carriers started covering the cost.

    Then, the news broke that the study had misreported the results. The media covered charges of fraud and insurance companies announced that they would no longer pay for BMT.

    What caused a well respected researcher to falsify data? Pressure to show "better" results to receive funds may have been a factor. The doctor may have been swayed by personal beliefs that allowed him to overlook problems with the trial in order to promote a therapy that he believed was beneficial. We will never know. Doctor Bezwoda denied the misconduct, and the scientific community and breast cancer patients are left wondering what direction to take.

    BMT is still being studied to determine whether it is worth the discomfort and risks. Even if doctors recommend this course of treatment, the costs without insurance coverage are prohibitive. BMT has proven worthwhile against other forms of cancer and the jury is still out on whether this could be an option for breast cancer. Unless current studies show that this procedure works better than traditional drug and radiation therapy, bone marrow transplant with high dose chemotherapy is an expensive and dangerous experiment.

     

    March 13, 2000

    Last updated April 21, 2017

    Elsewhere on the Web:

    BMT InfoNet
    Bone Marrow Foundation

     

     

     

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