Meet The Professors: Acute Myeloid Leukemia Edition, 2017 (Video Program) - Video 25Ara-C and its possible effects on subsequent transplant
1:43 minutes.
TRANSCRIPTION:
DR COLE: So in my patient who was not able to go for a transplant in first remission, which would have been ideal, do you think she’s been harmed by having had exposure to more high-dose ara-C before she actually does get to go to transplant? Or is there some kind of a detriment that’s happened because of the unidealness of the care she received? DR CORTES: I don’t think so. And, I mean, the reality on a patient like that, the way I tell patients is I tell them, “I need to make my plan like there’s not going to be a transplant. So I need to treat you the best I can, thinking that there’s not going to be a transplant. Once the transplant’s ready, you go there.” And in these circumstances you have the insurance issue, the donor issue, all these things. So for all you know today, the patient is not going to have a transplant. So you have to give them the best treatment that you can that’ll offer them the best chance possible without a transplant. If the transplant opportunity comes, definitely move her there, but in the meantime, the intensification of the ara-C, et cetera, is what you need to do. It doesn’t harm them. And you have to give them the best chance otherwise. DR STONE: I would agree. The only caveat that I would add is, if they’ve made it through 3 or 4 cycles of high-dose ara-C, the benefit of transplant at that point, you’ve already selected out the bad actors. So maybe they’re already cured. So if you’re talking about now she’s eligible after 6 months in remission, the benefit of transplant is less clear cut because you’ve already gotten rid of people who would have relapsed already. So, it’s a tough call. DR CORTES: You cannot cure the cured. DR COLE: Maybe we need to leave her alone. DR STONE: Maybe, if she’s already had that many. DR CORTES: Yes. There’s no question that the patients who haven’t relapsed within the first 6 months — you transplant then… |