Su Young Kim, M.D.: Tell me how do adult patients with AML do? Because I’m in pediatrics, I know what the kids do, but…
Jalaja Potluri, M.D.: Sure, so, AML in adults, by and large, the median age is in their sixties, so most patients in their sixties are unable to receive the standard intensive therapies. When you really look at their long term outcomes, patients who are over the age of 65 do very poorly. In fact, nothing has changed in their long term survival in the last three decades in that age group, as opposed to the younger patients where their survivals are very good. They’re about 40 to 50 percent. Tell me about how kids do with AML?
Kim: We do very well. So, about 30 years ago, it was probably in the same landscape where you are right now, at about 20 percent survival rates with these kids. Only in the last 10 to 15 years, we’ve actually gotten that number up to 60 percent, so now it’s different when you come for a diagnosis. You talk about you know, where are you gonna go to college, what are your plans later in life, and we keep those hopes alive, so they can have something to look forward to as you’re going through this intense chemotherapy. I think you have the same problem we do... We do a great job of clearing all of the disease cells in the body. There’s almost no detectable AML, and that’s like 90 percent of patients. But we know that they do reoccur, so about 30 to 40 percent of the patients will have reoccurrence. It’s got to be something about that stem cell, the one cell, the one to two cells that actually making all these AML cells, and I think that’s where we need to improve in the next 30 years or so, to figure out how to get rid of that, to actually make the overall survival much higher.
Potluri: Adult patients generally have a multitude of medical problems, so when you’re looking at the newly diagnosed patient with AML, they tend to have their co-morbidities, so you are looking at the physical characteristics of the patient, (and) you are also looking at the biology of the disease of AML. So by and large, patients with adult AML are not offered intensive therapy, due to their other co-existing medical conditions, and when you look at the disease biology, these patients tend to have higher aggressive features at a higher rate, such as complex cytogenetics, or less favorable chromosomal abnormalities, and up to a third of the patients also have secondary AML, meaning they had a pre-existing blood or bone marrow condition, that has, over time, emerged and transformed to become AML. It’s those disease biology characteristics that make it challenging for these patients, and particularly adult AML patients, to receive good therapy and have good outcomes.
Kim: Children are very resilient. I think people have this perception of them as fairly frail and vulnerable, which is more of a term I would actually apply to patients in your population: the grandfathers and the grandmothers. But children who – the best thing about treating children is they will listen to you. They listen to parents, they listen to you. And if you think it’s necessary for them, they will tough it out and they will do whatever’s necessary… obviously there are a lot of concerns: it’s emotional, a lot of it is emotional disturbances because of all of the emergencies that come on, while they’re in this hospital; they can’t do a thing, can’t go outside and play, which is one of the biggest things that they complain about.
Potluri: As we understand the biology of the disease, there have been a number of targeted agents that are being studied in AML. In fact, there have been a few approvals recently in AML. These, while these are important for patients with those specific abnormalities or mutations if you will, there’s other applications, so these agents can be combined potentially with the available therapy or low-intensive therapy, and to have better outcomes, so the field has changed tremendously and there are several other new agents that are being studied.
Kim: You know, we’re equally excited about these agents coming in. Our hope is we can reduce the amount of chemotherapy we give (with) the new agents; keep the same level, anti-AML activity, but reduce toxicity greatly. And so, we’re very excited about the future.