A diagnosis treatment combination is defined as a combination of compounds or treatment modalities that is prescribed at diagnosis of a disease or disease condition. Combinations are administered when a synergistic or additive effect is known or a protection can be anticipated.
In hematological malignancies the highest probability of disease free survival can be obtained by a fast remission-induction and consolidation of complete response at diagnosis followed by an allogeneic transplant in first complete remission to eradicate residual malignant cells. Effects of treatment that induce side effects are to be controlled to reduce treatment risks. Therefore, ablative allogeneic transplants are more and more replaced by non-myeloablative reduced intensity conditioning transplants. In acute leukemia these transplants have a much more dramatic course than in more indolent hematological malignancies and solid tumors.
In the Netherlands reimbursement for treatment components such as remission induction chemotherapy, an autologous transplant and an allogeneic transplant are currently reimbursed as independent diagnosis treatment combinations. Review of epidemiological data of cancer incidence and death in the Netherlands reveal that treatment of hematological malignancies are poor compared to projections in the United States. In the period 1997 to 2003 treatment results in the Netherlands are more or less stable except for Hodgkin’s disease; allogeneic transplantation has mainly been reserved for hematological malignancies (figure 1). Epidemiological data show that no improvement was achieved. In particular leukemia’s do poor. American Cancer Society projections show that there is a trend towards improvement in the USA for leukemias, non-Hodgkin lymphoma and in myeloma in the period 1997–2005 (figure 2).
Non-myeloablative reduced intensity conditioning autologous and/or allogeneic transplants are the curative element for transplantable diseases not curable by standard or intensified cytotoxic cytoreductive therapy. Critical also is rapid remission induction. Delay of transplantation to later stage than first complete remission only increases costs and risk of treatment or disease related mortality. We will present our protocol full of treatment plans to support in improving cure internationally. (www.transplantcreations.com).
Death/incidence ratio per 100.000/annum Netherlands
Death/incidence ratio per 100.000/annum USA
Disclosure: No relevant conflicts of interest to declare.
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