Andrew Artz MD MS Associate Professor of Medicine Clinical Director Hematopoietic Cellular Therapy Program Background New diagnostic tools New Drugs Blood and Marrow Transplant 2 Presentation Title Here ID: 774799
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Evolving Therapies for Elderly Patients with Blood Cancers
Andrew Artz, MD, MS
Associate Professor of Medicine
Clinical Director, Hematopoietic Cellular Therapy Program
Slide2BackgroundNew diagnostic toolsNew Drugs Blood and Marrow Transplant
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Outline
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Growth of Older Population: US Census Data
Centenarians (100+):
Account for 1.7% of population in 2010
United States Census Data
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Blood Cancers Mostly Occur in Older Adults
Lymphoma
CLL and others
AML, MDS and others
Milena Sant et al. Blood 2010;116:3724-3734
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Personalized Medicine: New Diagnostics and Treatment
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Immunotherapy: “Checkpoint blockade”
Nivolumab and pembrolizumab are examples
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Tailor Therapy to Fitness or “Physiologic Age”
Table
of Geriatric AssessmentDomainsWhat it measuresComorbidityOther medical conditionsFunction Physical fitnessSocial SupportAvailable social supportCognitionMemory and thinkingPsychologicalAnxiety and depressionNutritional statusUnder or overweightPolypharmacyNumber of medications
Slide8New ApprovalsAntibodies. Obinutuzumab* (gazyva), and ofatumumab* (arzerra)Targeted oral drugs: Ibrutinib (imbruvica), idelalisib* (zydelig), venetoclax (venclexta)ExcitingTargeted BTK acalabrutinib with 95% response rate in previously treated ptsCART cells
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CLL
Slide9New Approvals. None. Fast tracked FDAMidostaurin (AML with FLT-3) + chemo in younger pts. Average survivals 6 years vs 2 years without drugExcitingTargeted drugs for FLT-3, IDH New antibody drugs again CD25, CD47, CD33
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AML
Slide10New approvalsHiDAC inhibitor. Panobinostat* (farydak)Proteosome inhibitor: Ixazomib* (ninlaro), carfilzomib* (kyprolis)Monoclonal antibodies. Elotuzumab* (Empliciti), daratumumab (darzalex)ExcitingProof of above therapiescheckpoint inhibitorsautotransplant plus therapy before and after
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Multiple Myeloma
Slide11New approval. Blinatumomab (CD19+). 80% response for previously treated disease.ExcitingCAR-T cellsBlinatumomab with initial treatmentInotuzumab (ALL with CD22+)
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Acute Lymphoblastic Leukemia
Slide12For CMLAround 50% can stop drugs without return over 2 yearsCombination of drugs to get deeper responseAtypical CML/CNL. Rare type with CSF3R can respond to ruxolitinib or dasatinib.
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Chronic Myeloid Leukemia (CML)
Slide13MDS: No drug approvals!New TreatmentsRigosertib plus azacitidine. 84% responded (only 37 pts)Luspatercept improved anemia around 80%Aplastic anemia. Addition of eltrombopag, a platelet growth factor had high response combined with standard therapy
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MDS and Aplastic Anemia
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Buyer beware of “cures”!
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Many different targets!
Transplant in Older Adults
Gerberg, DE, Americal Family Physician: 2008:(3)
Slide16Trends in Allogeneic Transplants by Recipient Age*
Slide17Trends in Allogeneic HCT Utilization for Adults ≥70 Years, by Disease
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Absolute No. HCTs ≥70 Years
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From Prognosis to Optimization: Transplant Optimization Program (TOP) for Older Adults
Transplant in Older Adults
Interdisciplinary Meeting
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Summary
Personalized medicine is here. Each cancer and patient requires different treatment
New drugs and immune therapy are improving success
For fit older patients, transplant often an option