There has been some really encouraging data lately showing quite good long term survival for older patients receiving a reduced intensity transplant. I think this is due to improved transplant regimens and also improved supportive care that we have developed over the years. Compared to chemotherapy only, after achieving remission, allogeneic transplant can really offer improved survival for patients who are eligible.
How is the intensity of treatment determined?
The decision of whether or not to receive initial intensive treatment is largely based on fitness for such treatment. I think we are really redefining what fitness means by using a geriatric assessment to look at patients’ functional status and other comorbidities to get a better sense of who would be a candidate for intensive treatment. We want to make sure not to over-treat patients who are not good candidates for such treatment but also not to under-treat patients who we may be biased against but really are good candidates for that type of treatment.
Will geriatric assessment be seen in the clinical setting more?
I think that geriatric assessment is still investigational unfortunately. There is a lot of work being done to try to make geriatric assessment easier to do, shorter to do, and figure out ways in which it can be incorporated into general practice. Most likely by using either medical assistants or nurses or other personnel to actually complete the geriatric assessment and then provide that data to the physician to help them have a better conversation with the patient.
We are also having increased focus on geriatric haematology through the American Society of Hematology and I just wanted to mention that this is our third year of conducting a scientific workshop on aging and haematology at the American Society of Hematology annual meeting. Hopefully both at that meeting as well as at the ASCO meeting in June there’s going to be an increased amount of data coming about how to treat older patients with blood cancers.
Have there been any recent developments worth highlighting?
Most notably there is a drug called CPX-351 that was actually shown to provide better overall survival compared to our standard therapy for patients with secondary type of AML. 7 3 has been around since the 1970’s, many attempts have been made to improve upon it by adding drugs to it and those have largely been unsuccessful, so I think once CPX-351 receives regulatory approval it will be a new standard of care for patients with secondary AML and we are really excited to get that drug into practice.