Dana-Farber / Brigham and Women's Cancer Center

Older Adults with Leukemia:
Answers to five common questions

Older Adults with Leukemia: Five questions for Dr. Gabriela Motyckova

Gabriela Motyckova, MD, PhD

Gabriela Motyckova, MD, PhD

 

Dana-Farber/Brigham and Women's Cancer Center has established the Older Adult Leukemia Program, where leukemia patients who are 65 years-of-age or older are evaluated and treated by members of the leukemia team and a geriatric oncologist. Gabriela Motyckova, MD, PhD, a blood cancer specialist in the new program, answers five common questions.

What was the reason for setting up a special clinic for older patients?

The older leukemia population includes some of the most vulnerable patients because they are at more risk for toxic effects of treatment and because their outcomes are not as good as in younger patients. We wanted to include the expertise of a geriatric oncologist to help guide the choice of therapy, minimize toxicities, and enhance quality-of-life.

What are the challenges in treating blood cancers like AML (acute myeloid leukemia) in those who are 65 or older?

The cancer cells in older people tend to have accumulated more genetic damage and the cells often have developed resistance to our chemotherapy drugs. The leukemia doesn’t respond well to treatment – the rate of going into remission is lower, and the remissions are for a shorter time. At the same time, the older patients are at greater risk for complications of treatment – partly because they’re likely to have other age-related illnesses.

What are some of the treatment options for these patients?

Treatment options for older patients include intensive chemotherapy aimed at bringing about a remission, or lower-intensity chemo with fewer complications. Enrollment into clinical trials with investigational agents also is available. Reduced-intensity stem cell transplants (“mini-transplants”) are the only treatment that offers hope of a long-term remission lasting several years. Increasingly, we are doing these for patients up to age 75 who are relatively fit. Another choice is to monitor the patients with a “wait-and-see” approach, and treat them when necessary with care directed at symptoms alone, including transfusion and antibiotics. In some cases, patients may choose to have supportive care only.

What does the program’s geriatric component contribute?

Jane Ann Driver, MD, is the geriatric oncologist for the clinic. She conducts a comprehensive geriatric assessment, including life expectancy and the risks of morbidity from the cancer and treatment. Part of the workup is estimating the patient’s “functional age” rather than his or her calendar age – which can be quite different. The evaluation also looks for signs of Alzheimer’s disease or other dementia, which would create a higher risk of problems with treatment.

What benefits does this approach provide for patients and families?

For one thing, we can offer more intensive treatments based on their functional age and preferences. With the help of Dr. Driver, we work to optimize the treatment of the patient’s non-cancer illnesses. We can eliminate unnecessary or potential harmful medications they may be taking, to lower the risk of treatment complications. We also can help organize exercise and physical therapy, home visits by caregivers, and medication management. Overall, the goal is to increase active life expectancy and optimize function. Even small improvements in function can make a big difference in quality-of-life.

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