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Baricco and leukemia, when a second transplant is performed

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He announced this a month ago via social media, afterwards and with good news: “I had a second transplant, the disease had returned: it was a tough 41 days, but now everything is fantastic.” For example, the writer Alessandro Baricco explained last August 16 that he was in debt undergo a stem cell transplant for the second time, more than a year and a half after the first (performed in January 2022), because the leukemia from which he suffers has returned. The news shook fans, worried about a worsening of his condition: “Why did he have to have another transplant?”, “Can we really have two?”, “Is there still hope for recovery?”, are some of the most frequently asked questions that we have asked Fabio Ciceri, Director of the Department of Hematology and Bone Marrow Transplantation at San Raffaele Hospital in Milanwho performed the writer’s second transplant and is currently treating him.

The first transplant is successful in 80% of cases

Let’s try that first understand the reasons of a rare event. The neoplasm diagnosed by the writer, playwright, television author and radio TV presenter, namely chronic myelomonocytic leukemia, is in fact not particularly aggressive and the chances of definitive cure with an allogeneic blood stem cell transplant are good: the treatment is successful. on average in 80% of cases. Baricco therefore belongs to the least fortunate 20%., but even in this situation there are effective therapies. «In patients with this form of leukemia, transplantation is the only option that offers the possibility of definitive recovery – explains Ciceri. It is a delicate procedure, which involves heavy chemotherapy with the aim of completely eliminating the patient’s cancer cells and making room for healthy cells, which are then injected by the donor. However, along with the tumor, the chemo also resets the patient’s immune system and he must therefore remain in isolation for about three weeks, waiting for the donor’s stem cells to take root.”

When can the second transplant be performed?

However, it may happen that the tumor manages to resist and that over time relapse. The later it happens, the better, because it means that the disease is not very aggressive (Baricco’s first transplant was carried out in January 2022 at the Institute for Cancer Research and Treatment in Candiolo, in the province of Turin). During regular check-ups (every three, four, six months) the blood values ​​are changed and other specific tests can confirm this. What do we do at this point? «A second transplant can only be considered if three criteria are met
– Ciceri answers –: at least if the recurrence occurs after a certain time six (better 12 or more) months from the first transplant, if the patient’s condition is very good and if the patient responds to a so-called ‘rescue’ therapy (a heavy mix of chemo and other medications) that should be able to bring the leukemia back into remission. This means that in practice the ‘high’ blood values ​​must return to normal. If that is possible, you choose a different donor hoping that it works better than the first time, always staying as close to the patient’s family circle as possible.”

The chances of recovery

The possibility of recovery still exists, although another recurrence is always possible, along with the most feared complication of any transplant: «graft-versus-host disease» (it’s actually called Graft versus host disease or GVHD). an aggression towards the patient’s organism by the new immune system transplanted into him. It is rarely fatal and today it can be prevented and treated with immunosuppressive therapy modulated based on the individual case. The greater the donor compatibility, the lower the risk of graft-versus-host disease. And if the leukemia returns even after the second transplant, what are the prospects? “In case of relapse, the disease is always re-evaluated for the possible expression of new mutations that could become a target of targeted therapies,” concludes the expert.

Source: Corriere

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