Increasing the Chance a Transplant Patient Can Stop Immune Suppressants
To make a bone marrow transplant possible, patients require prolonged treatment with immune suppressive medications. Despite these medications, patients often develop graft-versus-host disease, a potentially life-threatening side effect that occurs when the donor’s immune cells attack the patient’s normal tissues.
This can have negative impacts on patients for years, affecting their quality of life, adding extra financial burden and increasing the need to take precautions that reduce the chance of getting infections.
A study presented at the Tandem Meetings aims to identify baseline features that can help predict which patients have a better chance of stopping immune suppressants.
Joseph Pidala, MD, PhD
“Understanding what proportion of patients can successfully stop immune suppressive medications after an allogeneic transplant is very important but also understudied to date,” said Joseph Pidala, MD, PhD, lead study investigator and oncologist in the Department of Blood and Marrow Transplant and Cellular Immunotherapy at Moffitt Cancer Center. “It represents an unambiguous long term success measure that you are fully well and able to come off those medications and live a normal life.”
The study, which is the largest and most comprehensive of its kind to date, included analysis of almost 19,000 patients who had undergone transplant. It also focuses on the current era of transplant medicine, not historical data, which takes into consideration modern technology used to improve outcomes.
The data shows only 15% of patients were off immune suppressants five years after transplant. However, the study also gives insight into what factors may help predict the success of immune suppressant discontinuation, which includes age, race, disease type, transplant type and the type of medication given to prevent graft-versus-host disease.
For example, Black patients, those with nonacute myeloid leukemia conditions and patients who underwent unrelated or mismatched transplant can have a decreased likelihood of being able to stop immune suppressant medication.
“We can leverage this large analysis to counsel patients on what is expected regarding the likelihood of being successful coming off these medications,” Pidala said. “The study also provides some clear evidence-based benchmarks that can be used in clinical and research applications.”
Pidala says researchers will now build a modeling-based tool that can analyze all of a patient’s risk factors to determine their individual level of success for coming off immune suppressants.
