Transplant for Older Patients with Dr. Nandita Khera - 2022

Leigh Clark:    Hi, everyone. This is Podcast for Patients with Aplastic Anemia Aplastic Anemia: (ay-PLASS-tik uh-NEE_mee-uh) A rare and serious condition in which the bone marrow fails to make enough blood cells - red blood cells, white blood cells, and platelets. The term aplastic is a Greek word meaning not to form. Anemia is a condition that happens when red blood cell count is low. Most… and MDS International Foundation. I'm Leigh Clark, director of patient services, and I'll be, uh, moderating the podcast today. Before we get started, I'd like to recognize the generous support of our corporate sponsors and our patients and families for supporting the podcast today.

[00:00:30]    Today we're gonna be talking about transplant for older adults with Dr. Nandita Khera, who is a professor of medicine at Mayo Clinic in Phoenix, Arizona. Welcome Dr. Khera.

Nandita Khera, ...:    Thank you.

Leigh Clark:    What is a stem cell transplant?

Nandita Khera, ...:
[00:01:00]

[00:01:30]    So a stem cell transplant is a procedure in which bone marrow bone marrow: The soft, spongy tissue inside most bones. Blood cells are formed in the bone marrow. that is diseased or damaged, is replaced by stem cells stem cells: Cells in the body that develop into other cells. There are two main sources of stem cells. Embryonic stem cells come from human embryos and are used in medical research. Adult stem cells in the body repair and maintain the organ or tissue in which they are found. Blood-forming (hemapoietic) stem… from either the patient themselves, that is called autologous transplant; or from another donor, and that is called allogeneic transplants. Usually for our myelodysplastic syndrome patients or, uh, other bone marrow failure bone marrow failure: A condition that occurs when the bone marrow stops making enough healthy blood cells. The most common of these rare diseases are aplastic anemia, myelodysplastic syndromes (MDS) and paroxysmal nocturnal hemoglobinuria (PNH). Bone marrow failure can be acquired (begin any time in life) or can be… patients, the type of transplant we do is the allogeneic transplant which is getting donor cells, uh, from a different donor. The rationale for doing this is the hope that the newly transplanted immune system will attack the disease cells and therefore help eradicate, and this is called something, uh, as graft versus tumor effect and can pro- provide a potential cure to the disease.

Leigh Clark:    Thank you. Does age play a role in determining the eligibility for transplant? And if so how?

Nandita Khera, ...:
[00:02:00]

[00:02:30]    That's a great question Leigh. Um, age traditionally has been an important factor in deciding as to who can get a transplant. Some programs like, uh, our bone marrow transplant bone marrow transplant: A bone marrow transplant (BMT) is also called a stem cell transplant (SCT) or hematopoietic stem cell transplant (HSCT).The procedure replaces unhealthy blood-forming stem cells with healthy ones and offers some patients the possibility of a cure. But for many patients, a BMT is not an option due… program here at Mayo Clinic Arizona, we do have a soft cutoff at 75 years, beyond which we seldom will transplant. However, there are a lot of other programs in the country that will, um, continue to evaluate patients who are much older than that. Um, they'd rather look at factors such as what are the other medical problems or what is the functional status or performance status of a patient that may impact the transplant outcomes. You know, in fact, there was a recent national study, um, done that is now analyzing their data. And what they want to find is if there can be a composite health risk assessment, in addition to age, that can help inform selection of older patients for this intensive and complicated transplant procedure.

Leigh Clark:    Thank you. What are the factors determine if a patient is eligible for a transplant?

[00:03:00]
Nandita Khera, ...:    
So, as we just talked, age, um, functional status, comorbidities or other medical problems are some of the main factors. Uh, in addition, um, how their organ function is, and other medical, uh, issues such as, what is the degree of control of their disease? So certain diseases which are progressing very rapidly and not being controlled by the current treatments can be really hard to, um, successfully transplant.

[00:03:30]    In addition, there are social demographic factors such as, um, appropriate insurance coverage, uh, requirements for a caregiver and adequate social support that also go into determining the eligibility for transplant.

Leigh Clark:    Thank you. Uh, what determines the success of a transplant?

Nandita Khera, ...:

[00:04:00]

[00:04:30]    Um, in general, transplants are more likely to be successful if the disease for which we are transplanting the patient is in remission or under good level of control. And for aplastic anemia patients, we do try to get to transplant sooner in the course of the disease if we can, um, if they have severe aplastic anemia so that they don't have... they're not, um, in a position that they've received a lot of transfusions and things like that before. Other factors that determine success include good organ function, um, no uncontrolled, untreated infections, uh, good functional status and nutritional status, and adequate psychosocial support with caregivers financial reserves, and so forth.

Leigh Clark:    Thank you. There was a national study done, um, to determine, um, the role of transplant in older patients. Could you tell us a little bit about the study and what they discovered?

Nandita Khera, ...:
[00:05:00]

[00:05:30]    Yes, absolutely. So, um, last year, this practice-changing study was published. This was a national study done by our Blood and Marrow Transplant Clinical Trials Clinical Trials: Clinical research is at the heart of all medical advances, identifying new ways to prevent, detect or treat disease. If you have a bone marrow failure disease, you may want to consider taking part in a clinical trial, also called a research study. Understanding Clinical Trials Clinical… Network. And what they looked at was, um, they looked at patients who were 50 to 75 years old with high-risk MDS who were eligible for transplant. Um, and the patients were assigned to a transplant arm if they had, an adequate match sibling or a matched unrelated donor unrelated donor: A donor that is not a sibling or other familial relation of the patient (recipient). , versus, uh, just the physician's discretion with a hypomethylating agent or best supportive care supportive care: Care given to improve the quality of life, or comfort, of a person with a chronic illness. Supportive care treats the symptoms rather than the underlying cause of a disease. The goal is to help the patient feel better. Patients with low blood counts may be given blood transfusions as supportive… if they didn't- didn't have a donor. And what the study showed was that the patients who received the transplant did better, both from an overall survival standpoint and from leukemia's, uh, free survival standpoint at three years from enrollment.

[00:06:00]    They also examined quality of life, which was found to be quite comparable between the two groups. And so the final conclusion of the study was that allotransplant should be considered an integral part of the treatment for, um, for myelodysplastic syndrome patients, especially those that have intermediate or high-risk, uh, myelodysplastic syndrome and that we need to promote early referral for transplant.

Leigh Clark:    Thank you Dr. Khera. Uh, any advice for patients when they are looking at a transplant? Maybe some questions that they should ask, um, to the transplant team?

[00:06:30]
Nandita Khera, ...:

[00:07:00]    
Yes. Um, I would say first of all, starting with even the regular hematologist hematologist: (hee-muh-TOL-uh-jist) A doctor who specializes in treating blood diseases and disorders of blood producing organs. that they are seeing, they should pose the question if transplant is an option for them and if they should be referred to a transplant center. And then when they actually look at a transplant center, they need to look at... Um, so the data for the transplant center outcomes is published, um, nationally. It's freely available. Um, they should look at if their insurance will cover their transplant based on, um, their policies and so forth. And then when they meet the transplant team, they should ask all the questions about the, um, medical complications and the emotional and the psychosocial complications, um, around transplant.

[00:07:30]    Most transplant centers have multidisciplinary teams in addition to the physician and transplant nurse, including case managers, social workers, pharmacists, and, uh, nutrition, um, specialists. And so we usually, uh, strive to provide a very all-rounded care to the patients, uh, but patients do need to be proactive and asking all the, uh, relevant questions for determining the success.

Leigh Clark:

[00:08:00]    Well, thank you so much Dr. Khera for sharing your time and your expertise with all of us today. You can find out more about bone marrow failure diseases on our website at AAMDS.org, by following us on Facebook, Instagram and Twitter, or you can give us a call at 800- 747-2820. This concludes our podcast session.