Cancer treatments are not without risks, failures

Patients given a potentially deadly diagnosis of cancer often don't understand that treatments also pose risks. And while bone marrow transplants may cure many of those cancers, patients must know it is never a quick or risk-free process, according to Dr. Julie Asch, associate medical director of the Intermountain Blood and Marrow Transplant Program at LDS Hospital.

Asch and Dr. Finn Bo Petersen, medical director of the transplant program, will be featured on today's Deseret Morning News/Intermountain Healthcare Hotline. From 10 a.m. to noon, they'll answer questions about transplants, blood and marrow-related diseases and risks.

A bone marrow transplant may also be used for other diseases and conditions, including genetic metabolic defects, auto-immune system dysfunction and some anemias.

If the marrow is taken from an individual to be used in that person, it's called an autograft. Marrow donated from someone else is an allograft.

The word "cure" looms large for someone who is very ill and perhaps will die from a disease, Asch says. Often, other words like "risk" and "potential" get filtered out. It is the job of staff at a bone marrow transplant center to see that doesn't happen, she says. The danger is real and for some people, it simply might not be worth it.

If everything goes perfectly, it will be at least a year of monitoring and treatment following a marrow transplant, which is given as an infusion. More realistic is two or three and in some cases eight or nine years for full recovery. During that time, an individual's immune system doesn't work well. The list of medications that may be required can be "enormous." And in cases where the donor immune cells recognize the patient's cells as foreign — a kind of reverse rejection called graft vs. host disease — the challenges may become chronic, although specialists are pretty good at dealing with them, she says.

Patients are given medications early on to stop such attacks from happening, but that increases the risk of infection because the immune system is suppressed. In such cases, patient quality of life can be impacted not only by physical symptoms, but by the need to be somewhat isolated.

When she talks to patients, Asch says she tries to relate the most typical course, as well as the best and worst scenarios, because no one can predict with certainty what will happen with a particular patient. Patients are provided with a detailed letter that helps them understand and to which they can refer as needed. Usually, the extended family is also invited to a meeting with transplant program staff to ask questions and talk about what's likely or possible.