The benefits and harms of high risk Chemotherapy:

[spasticone]

The benefits and harms of high risk Chemotherapy:

Consider the case of and individual who was diagnosed with the chronic myelogenous leukemia (CML). This person responded well to initial oral chemotherapy treatments and CML has entered in a latent phase. However, at this point his oncologist outlines his future options. He could continue with the interferon alpha and the CML could remain in its latent phase for years- but there is no way of knowing how long this latent phase would last. Or, if he wants to be cured, he could have high dose chemotherapy and stem cell transplant. This is a very aggressive treatment that is the only therapy proven to cure CML. However, the risk of this treatment is substantial and it is not inconceivable that he could die from the treatment itself. is there a moral reason to perfer one course of treatment over the other?

[midnightmoon]

There is no moral factor to the stem cell transplant. The stem cells used will come from an adult donor and will be either bone marrow or peripheral blood stem cells. The stem cell transplant is essentially a bone marrow transplant. They call it a stem cell transplant today though, because the same type of stem cells in the marrow that make the transplant work are also found in the circulating blood and cord blood. Peripehral blood stem cells are the cells most often used in the transplant.

The treatment is risky. People do die going through it, I wont lie. But, many people go through it, survive it, and never look back.

I had the transplant almost 2 years ago for a different type of leukemia, aml. I more or less had no choice, as acute leukemias progress and kill far faster than the chronic leukemias. If he opts for the transplant, they will make sure you are healthy enough otherwise to go through it. He will be in the hospital for 6 weeks, and in daily out patient care for another 6 weeks, and it takes about a year or longer to fully recover. I had complications with gvhd, so two years out, I am still recovering.

The largest risk is infection. He will have high dose chemo and possibly full body radiation. The purpose of that is to kill his existing marrow (where the cml originates) so there is room for the transplant. However, as the marrow forms the immune system, he will have no immune system for up to a couple weeks while waiting on the new cells to engraft. He would be in isolation and in an icu unit to minimize those risks, but they are there and they are high.

There are other risks such as gvhd, complications with reproductive system (the transplant through me into menapause... at 23 years old).

He should have a consultation apt with his docs and discuss the possibility of a transplant and what it involves and the specific risks involved in his case. He should also make sure he has the transplant done at a bigger hospital who does the transplant on a reg basis.

[TweetyBird]

The decision to pursue one course of therapy rather another is a personal decision and a patient's decision. It's an informed decision made with the full knowledge of the known risks and benefits. While a doctor can outline a therapy and identify all risks and benefits, no physician can make the choice for a patient. And all patients have the right to refuse any or all forms of treatment. So since this is a decision made by the patient, I don't see how morality plays into it.