Meet The Professors: Acute Myeloid Leukemia Edition, 2017 (Video Program) - Video 21Transplantation for older, healthy patients with unfavorable cytogenetics
2:09 minutes.
TRANSCRIPTION:
DR JOHL: One question is, in my practice we see a lot of patients in the early seventies with unfavorable cytogenetics. We have induced them in many situations. In terms of transplantation, again, I mean, we’ve talked about this in the past, but what about age as a cutoff for a healthy, fit, early patient in the early seventies with unfavorable cytogenetics? At what point do you consider transplantation? Or at what point do you draw a line, saying, “This patient is not a transplant candidate”? DR STONE: I think, as Jorge mentioned earlier, age is probably a weak dividing line. However, arbitrarily at our center, just to give you an idea, 75 is the line, just because of resource utilization/life expectancy. From a biological standpoint, there’s no reason to draw the line there, in my opinion. As a matter of fact, I have a 79-, 80-year-old patient who had 2 autotransplants and 1 allogeneic transplant at the University of Massachusetts Medical Center, and he’s doing great. He comes to see me and asks me if they’re doing the right thing. Obviously they are, because they saved his life. Just because I happen to be in Boston, he thinks I know what I’m doing. But it’s ridiculous. So 75 is a reasonable cutoff, but some centers do them up to age 80. And I don’t know what the policy at MD Anderson is. DR CORTES: It’s 75ish. I mean, I was thinking. We’ve transplanted, of my patients, I can remember a 76- and a 78-year-old who were transplanted. But those are exceptions, because among other things, resource utilization and financial clearance, it’s hard on an older patient. The insurances, they tend not to do these. And there’s many reasons why. I like running. And when I finish the runs and I look at the marathons, there’s always some 75-year-olds that ran much faster than I did. So, I mean, and because we do now nonmyeloablative and all these things, age is not alone the factor. |