Summary: Advanced age has traditionally been seen as prohibitive for treatments like stem cell transplants and CAR T therapy. This presentation reviews evidence that overall fitness is a crucial factor in reducing non-relapse mortality and that otherwise healthy elderly patients can have successful outcomes after transplant and CAR T-cell therapy.
Presenter: Mariam Nawas MD, University of Chicago
Many thanks to Kite, a Gilead Company whose support helped make this Survivorship Symposium possible
To read the transcript, go to:
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Highlights:
Older patients are often not considered eligible for stem cell transplants for AML and CAR T therapy for lymphoma simply based on their age.
Frailty and fitness can be more important than age in assessing a patient’s suitability for stem cell transplant or CAR T therapy. Frailty and fitness can be measured by a geriatric assessment that evaluates multiple domains of health.
If older patients are well-selected through prior testing, they do not have much higher non-relapse mortality rates when compared to younger patients. Age alone should not disqualify older patients from eligibility for stem cell transplant or CAR T therapy.
April 2024, part of the Virtual Celebrating a Second Chance at Life Survivorship Symposium 2024
Presentation is 40 minutes long with 19 minutes of Q & A.
Key Points:
(02:09): Blood cancers are primarily diseases of older adults.
(06:41): Transplants and CAR T therapy are underutilized in older patients with blood cancers because of a lack of referral by community oncologists who assume they are not good candidates based on their age.
(07:42): Perceived frailty among older patients often prevents doctors from making referrals for stem cell transplant or CAR T therapy.
(09:10): Frailty and age are related but age alone is not a good measure of frailty so fit, older patients may not be referred for transplant or CAR T therapy.
(14:00): Patient-reported data is also important in assessing fitness versus frailty in patients.
(21:20): Comorbidities like other health issues have a big impact on non-relapse mortality.
(23:24): A Transplantation Optimization Program (TOP) at the University of Chicago proved highly predictive of which patients were at risk for non-relapse mortality.
(26:37): Screening patients through tools like the TOP program and other measures of fitness can mean that older age does not increase the risk of non-relapse mortality.
(28:28): Reduced intensity conditioning before transplant can make it safer for older patients and they seem to do just as well as younger patients.
(31:54): Measured by efficacy and survival, outcomes of CAR T therapy in older patients are quite similar to those of younger patients.
and survival, outcomes of CAR T therapy in older patients are quite similar to those of younger patients.
Note: Throughout this workshop the terms bone marrow transplant and stem cell transplant may be used. For purposes of this talk, they mean the same thing: transplanting hematopoietic or blood forming stem cells into a patient.
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8 май 2024
