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Stem Cell Transplant Outcomes Improve for Older Patients

Older patients with acute myeloid leukemia (AML) who received an allogenic stem cell transplant have shown improved survival rates over the past two decades, according to a study published online March 22 in Clinical Cancer Research. (The journal is published by the American Association for Cancer Research, which also publishes Cancer Today.) In allogenic hematopoietic cell transplantation (allo-HCT), blood stem cells are taken from a matched donor and transplanted into an AML patient. Allo-HCT is a second-line treatment when targeted therapies or chemotherapy fail. Using data from a large transplant registry, researchers looked at 7,215 AML patients over age 65 who received allo-HCT between 2000 and 2021 and examined overall and leukemia-free survival after a median follow-up period of 40 months, Healio reported. Three years after receiving the transplant, 63% of patients treated from 2000 to 2009 had not relapsed. This increased to 69% for those treated from 2010 to 2014 and 70% for patients treated between 2015 and 2021. Leukemia-free and overall survival after three years improved significantly over the three time periods. Leukemia-free survival increased from 32% to 38% and then to 44%, and overall survival improved from 37% to 42% to 49%. “These data indicate that allo-HCT should no longer be optional but should be mandatory for elderly patients,” Ali Bazarbachi, senior author of the study and a hematologist-oncologist at the American University of Beirut in Lebanon, said in a press release.

Cervical Cancer Rates Climb for Women in Low-income Counties

Cervical cancer incidence and mortality rates have declined over the past few decades in the U.S. due to increased screening and the 2006 approval of a vaccine for human papillomavirus (HPV), an infection that causes more than 9 of 10 cervical cancer cases in the U.S. But a recent study published in the International Journal of Cancer found that cervical cancer incidence has increased for women living in low-income counties. Using Surveillance, Epidemiology, and End Results data, researchers looked at cervical cancer incidence rates from 2000 to 2019 and mortality rates from 2005 to 2019 by county-level income and race/ethnicity. Among non-Hispanic white women from low-income counties, cervical cancer incidence grew by 1% per year and advanced cancer cases grew by 4.4% per year. For Hispanic women living in these counties, advanced cervical cancer increased 1.5% per year. Mortality rates increased by 1.1% per year in white women and 2.9% per year in non-Hispanic Black women living in low-income counties. Some experts believe the increases might be linked to fewer cancer screenings and interrupted follow-ups with health care providers after screening. “Part of the problem is that groups are not being screened on time, which can lend itself to developing cancer,” said Trisha L. Amboree, an epidemiologist at the University of Texas MD Anderson Cancer Center in Houston and the study’s lead author. Screening rates for cervical cancer dropped sharply during the COVID-19 pandemic. In 2021, 4.4 million fewer women in the U.S. underwent the screening compared with the pre-pandemic year of 2019, according to an article in The Hill. Additionally, Amboree and others said they also believe many women who receive an abnormal screening result delay follow-up with health care providers.

A Gene Test for Chemo Sensitivity Could Save Lives

More than 275,000 cancer patients in the U.S. each year are infused with fluorouracil, known as 5-FU, or take a similar form of the drug in a pill called Xeloda (capecitabine). These chemotherapy drugs are used to treat a variety of cancer types, but patients who lack an enzyme that metabolizes the drugs could have a severe reaction or even die after receiving them. Possible effects on these patients include diarrhea, nausea, and mouth or gut inflammation. For these patients, the drugs stay in their body for hours instead of being quickly metabolized and excreted. 5-FU and Xeloda kill an estimated 1 in 1,000 patients who take them and lead to severe illness or hospitalization in about 1 in 50, according to a KFF Health News story. Doctors can test for the enzyme deficiency and switch patients to another drug or lower the dosage if they test positive, but a recent survey published in JCO Oncology Practice found that only 20% of oncologists in the U.S. had ever ordered the test before giving patients 5-FU or Xeloda. U.S. cancer treatment guidelines issued by the National Comprehensive Cancer Network, the mostly widely used guidelines, don’t recommend the test before treating patients with the drugs, nor does the Food and Drug Administration (FDA) require doctors to administer the test. Pharmacist and researcher Daniel Hertz of the University of Michigan College of Pharmacy in Ann Arbor has joined other providers in petitioning the FDA to put a black box warning on the drugs’ label urging prescribers to test for the enzyme deficiency. “FDA has responsibility to assure that drugs are used safely and effectively,” he said in the KFF News story, calling the agency’s failure to warn prescribers “an abdication of their responsibility.”