2010 American Society of Hematology Annual Meeting 3rd - 7th December
Prof Lodovico Balducci - Moffitt Cancer Center, Florida, USA
ecancer symposium on the treatment of elderly patients with haematological cancer
LB Ludovica Balducci
LB Because most of haematological malignancies from acute leukaemia to Non Hodgkin's Lymphoma to multiple myeloma are found prevalently in older people. The median age for this disease is between 65 and 75. Consequently older people represent the great majority of these patients and the older people in general, with the exception maybe of lymphoma, are being grossly undertreated, so it is very important for clinicians to learn how to evaluate older people and how to provide these older people with the proper treatment. Lymphoma, myeloma nowadays are, if not curable, certainly a disease where the life, the so-called active life expectancy that is a most important end point when you starting the aging can be prolonged, and it's very important that these older people be not deprived of this advantage.
I would like also to emphasise another disease which is becoming more and more common and that is grossly under-looked in older people and that is myelodisplasia. Myelodisplasia is, as you know, preleukaemia, is a disease which is found mainly in older people, is practically a disease of aging. And unlike the past when myelodisplasia was, there was very little we could so beside doing, giving blood transfusion, nowadays there are drugs which is, which are well tolerated by everybody, including older people, and that prolong their life and, I insist, the active life expectancies of these older people.
So I think one of the issues that we will emphasise there will be it's very important that the haematologists throughout Europe and throughout the world become more aggressive in identifying myelodisplasia, in working up anaemia in older people. Until now there was a prejudice that anaemia is a common consequence of aging; anaemia is not a common consequence of aging. Most of the anaemias are lethal in older people, most of the anaemias are reversible and some of the anaemias are myelodisplasias can be treated with a substantial improvement of the active life expectancy of these people.
IV And can you tell me something about the meeting itself, what will be happening and which particular issues do you think are going to emerge as the really important ones?
LB I… the way we have structured the meeting is there will be a, first of all a discussion of the biology and of the assessment of aging, okay, why is cancer more common in older people? What are the biological changes of aging? How we can we establish how old an older person is?
IV So aging is the key issue, not necessarily disease by disease?
LB No, aging is the major issues but there are other key issues. One is to establish whether the nature of the disease changes with aging. For example, acute myelogenous leukaemia is a different disease in older and younger people and we need to become more familiar on how to treat acute myelogenous leukaemia in the elderly.
Right now this, at this meeting - unfortunately I won't be able to attend that - but there is an abstract showing that Clofarabine is a relatively new drugs, seems to be very effective even in those forms of acute leukaemias that are resistant to other treatment, especially in older people. So I think it's very important to keep these present.
IV And the natural history of the disease can be different?
LB The natural history of the disease can be different and the response of the disease to treatment can be different.
IV So what will doctors attending the Rome meeting be able to learn from it?
LB I think the first thing they will learn will be how to assess older person, how to establish which older person will be able to benefit from the treatment. The second thing that they will be learning will be what are the current results of treatment of older people with acute leukaemia, lymphoma, multiple myeloma, the haematological malignancies and how to, what are the questions that are still open, what can be done and what we need to find out. And the third issues I think will be very important will be a framework to establish how to work up the anaemia of the older person so that there are not so many older person who suffer unnecessarily from the consequences of anaemia which includes death, functional dependency, etc.
As I said, many of these anaemias are reversible because they may be due to the drugs that the patient is taking, may be due to their physiological deficiency of iron, of vitamin B12, and may be due to decreased renal function. But the most important thing for our meeting will be to identify early diagnosis of myelodisplasia.
IV Myelodisplasia is very interesting. It is quite neglected at times, isn't it?
LB Not any more in the United States but, yes, it's mainly neglected because many older people with anaemia are not referred for a proper work up. And many of the haematologists around the world probably feel that a low haemoglobin is a physical consequence of age, which it's not.
IV What is the scope of improvement that could be achieved clinically by addressing myelodisplasia properly, appropriately?
LB Well, I think the most important issue will be many more people will receive the proper treatment and they will live longer and will live a better life.
IV And they will not progress to leukaemia?
LB Is exactly right, we cannot cure myelodisplasia; the only way to cure myelodisplasia is bone marrow transplant and not many older people are candidate for that. Also right now we have the reduced intensity in psychotherapy that may be, may increase the scope of the candidate.
IV offers promise, because it's always been difficult to really make… to work. What about quality of life, let me just ask you finally, because I'm sure many doctors will be concerned about getting the balance between the aggressiveness of the therapy and optimising the patient's quality of life?
LB Well, I'm going to give you an answer that probably you don't expect and that I am probably… because I don't like the concept of quality of life. Not because I don't believe in quality of life, but because I don't like the idea that quality of life, that you can measure the quality of life. Life is according to Christian theologies abonum omticum; it's something which is worth on its own and so it's not something which value can be measured.
I believe in talking about quality of health which is something that instead can be measured, so it really improved the quality of health of these people. But, more important than that - and I think we can agree on this concept - will improve their active life expectancy, will improve the period of time during which a person is functional, independent, can be himself or herself, and that I think is the most important issue.
IV And in a word, a clinician's reason for either going to the Rome meeting on blood cancer in the elderly or following what happens there on ecancer or any of the other excellent sources?
LB It's to learn how to provide the best current treatment of cancer, haematological malignancies, but in the case of the Rome meeting the best treatment of haematological blood cancer and anaemia in the elderly. And improve the, prolong the active life expectancy of older people, to have older people who are more self satisfied, more independent, more able to be active and productive member of the society.
IV Ludovica, it's been a really pleasure talking with you, thanks for joining us on ecancer TV and we'll hope to talk with you many times in the future.
LB It's been a real pleasure, thank you.