Ideal age for a transplant

Hi everyone,

I was wondering what the ideal age for a bone marrow transplant was in thalassemia major and thalassemia intermedia.  I was told by a few doctors that the earlier you get it done in life, the better the outcome.  Does anyone happen to know the risks involved as you get older, and whether or not you can tolerate chemotherapy with an enlarged liver?  Is there an age where it would not be recommended?  I read some stuff about the Lucarelli staging criteria, and I saw that it was around a 60% chance of life free complications after the transplant if you are an adult.  Can anyone confirm these statistics?  http://www.thalassemia.com/bmt_3.html. Thanks much.

-David

It is not so much age that interferes with BMT success ratio as all the other things that go on with a thal as (s)he ages. These are the areas that a BMT specialist looks at to estimate chances of success:

1. Number of transfusions - less is better
2. Chelation - higher is better
3. Damage to body organs, especially heart and liver - obviously, less is better

Hence, a minimally transfused, well chelated patient with intact organs has the best chance of getting a successful BMT. This usually coincides with younger thals.

Hope that helps.

Poirot

Yes, it helps very much.  Thank you for your reply.

-David

Adults do have a much lower survival rate for BMT than children. The adult rate is around 65%, compared to as high as 90% for children. Newer protocols for preparation of the patient has slightly improved the survival rate in adults. Chelation compliance is a major factor in success rates.

There is an excellent set of articles at http://www.cordbloodforum.org/biblio/ash2005/thal_sickle.html

From, Long-Term Outcome after Bone Marrow Transplantation for Adult Thalassemia.

Adult thalassemics constitute a high risk group of patients for transplantation due to both advanced age and acquired multiple organ damage.

BMT is not regularly done with thal intermedia patients. The life expectancy is much longer in intermedia and the risk of BMT may be too high in relation to the life expectancy. However, in intermedias with high transfusion requirements, it is done.

http://www.emedicine.com/ped/topic2232.htm

In patients with severe thalassemia intermedia who require aggressive therapy to sustain life, bone marrow transplant, similar to that performed in patients with thalassemia major, is a reasonable alternative to transfusion and chelation if a matched sibling donor is available.

BMT is done in patients with more advanced problems and the survival rates are lower. See the tables at

http://www.thalassemia.com/bmt_3.html