Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

I am here today with Richard Lin. We're going to talk a little bit about allergy, Ellick stem cell transplants. Uh and a summary of, of what doctor was talking about at Asco this year before we begin, Richard, would you mind maybe giving us a quick introduction to you some of your research interests and then we'll dive into allergenic stem cell transplantation. Okay. Thank you, Phil. Good morning, everyone. Uh My name is Richard Lin. Um uh I'm a stem cell transplant physician, uh the car T cell physician and the Memorial Sloan Catherine Cancer Center. My clinical and research interest is actually caring for older patient's with uh advanced hematologic malignancies such as leukemia lymphoma. Uh You know, in the setting of leukemia, obviously, we do mostly uh large in a stem cell transplant in the setting of a car T cells. In the setting of informa, we mostly perform car T cell therapy, uh security of intent treatment modality. My specific interests are again caring for older patient. So today, I'll briefly mention uh some of the work I discussed that uh um precedent for older patient and provide some sort of what we think about this in the next uh you know, 10, 15 years. Uh So I'll just write dive in the take home message for transplant in older adults with AML is basically three things. One is allegedly transplant remains uh viable, potential security options for older adults with AML. Despite recent advances in uh approval for many, many uh noble therapy drugs and to uh those normal therapies, they actually will help uh improve the outcome of allergen a transplant and help potentially improve the rates of the patient's going to the transplant. And this in combination with multiple recent advances in the transplantation platform and transplant technology would presumably lead to better outcomes for older patient uh in transplantation. And then lastly, I want to emphasize that we need to incorporate geriatric assessment both as assessment too, as well as the management tool for older patient going through treatment for their leukemia and uh all the way through the uh transplant process. This will again help improve the outcome for this group of Boulder patient's. Um So traditionally, for older patient with aml, the survival outcome is very poor. Uh less than 20% patient will be alive in 5 to 10 years after their diagnosis. This is because as you can imagine, many older patient's are traditionally uh have many medical conditions, medical comorbidities. Uh they may have functional impairments and they may not have the optimal social support system and make things even worse. Many older patient's, their leukemias are considered the highest risks because they have antecedent myelodysplastic syndrome or they have received chemo radiation therapy for other cancers such as lung cancers, breast cancer, and prostate cancer in their life. As a result, those other patient's, you really have a higher risk of diseases and a large in a transplant remains the only curative options. But uh very selective group of patient's are you really considered candidates? So that's why most of other patient will eventually die after being treated for the traditional non transplant based therapy. We have a lot of data actually uh in the recent years, suggesting that transplant approach is still superior than non transplant approach uh for this population patient. If they were able to get to the transplant, the key is how do they, how are they going to be selected and how do we optimize them to get the transport? Uh So the first key is to make their treatment, initial treatment much more tolerable, have less side effects so that it can in good shape to actually be considered a transplant candidate. And the way to do this is that to harvest the uh powers of the newly approved medications. Uh giving some examples of newly approved medication that including Annetta class uh including uh the I D H inhibitors and also uh noble drugs that target different pathways such as money pathways um or selling headshot pathways. So those inhibitors, uh those noble therapies, most of them are oral treatment. And some of them are IV infusions, but they generally have much less toxicity than uh compared to the traditional seven plus three regiment. So as a result, the patient's, they have more patient under into uh complete response after treatment. But also once the complete induction therapy there in much better shape, uh physiologically uh compared to the patient traditionally uh received seven plus three or intensive induction therapy. So I think this is going to be a big advantage going forward. And the second big advantage uh is that the transplant platforms has improved significantly over the last two decades. The transplant technology has a lot of major advances. The conditioning regiments are now less toxic, has more better, untitled ceemea effects. We now have much better choices for donors because of the development posttransplant, Cytoxan as a result, those patient who traditionally only have mismatched donors can now safely undergo originate transplantation, which which similar outcomes compared to traditionally well matched donors. So this is basically allows us across H I O A barriers to offer pretty much everyone a donor uh who's in need. And then lastly, we have now better strategies to manage transplant related complications such as uh CME reactivation. We have better drugs to treat it to prevent it. And we also have better drugs to prevent and trade graft versus host disease. Both acute and chronic, which are considered the most uh traditionally most difficult complications facing uh patient, considering transplantation. So all those advantage has lead to unprecedented uh improved outcome for older patient undergoing a logically transplantation. So as you can imagine, you have a better induction regimen, you have better transplant platform. So now you're making this potential curative uh treatment modality much more probable uh to patient's and to the clinicians. And then lastly, uh I want to discuss the role of geriatric assessment. So the geriatric assessment is a potential to uh comprehensive assessment to that uh examine older persons, physical cognitive uh psychosocial nutritional and medication status to identify the vulnerabilities and impairment of older persons overall house. And most importantly, the design strategies to remedy well deficit and to optimize a person older persons outcomes uh prior to any therapy including election a stem cell transfer. So there's a lot of evidence in recent years that uh director assessment can help patient with AML through the induction therapy and through the transplant. And the key is to incorporate that through the treatment, continue from beginning all the way to the transplant. This would allow further optimization of the older candidates. So they can uh improve their outcomes after transplant and as well as the quality of life. So, so in summary, because of those three major advances, again, improvement in conditioning, uh sorry, improvement in the induction therapy for AML with the novel therapies and improvement in the transplant platform and transplant technologies. And finally, uh use of geriatric assessment to help optimize older patient's status and all those things combined together makes the future of a login a transplant for older patient with AML very promising uh I anticipate in the next 10 to 15 years. The originate transplant will remain a very viable options for other patient's with leukemia. And with the goal of achieving cure, the key is to uh make sure everybody is aware of those advances to make appropriate early referrals for other patient's with ML to consider transplant. Because all the things I discuss here need to be planned early and they need time to be carried out uh in the well manner. So that's why early referral is the key. Uh If you consider uh other patient with uh A M L for transplant and uh not just to let the age itself um to, to deter you from doing that, I will say the patient from age 60 to 75 should be considered automatic referrals for transplant if they are reasonable uh baseline, reasonable performance status for age over 75 probably easier just to discuss with transplant center who has expertise uh for older patient directly. Uh So that's sort of my uh take home message for consider this uh topic of uh transplant for other patient with uh leukemia. Uh Maybe in one minute, I want to briefly mention an important studies from the esko this time is on carticel therapy for patient with uh aggressive uh primary refractory or early relapse diffuse large B cell lymphoma. This is a commercial product with XSL that's improved worldwide. And this study is basically a long term follow up of the initial Zuma seven study which look at the uh compare of car T cells with traditional uh chemo uh salvage chemotherapy followed by a part of the stem cell transport. And in the initial publication, it was shown that the cortisol offer PFS advantages over traditional salvage chemotherapy followed by the target stem cell transplant. In the patient was diffused, which the patient was aggressive, high grade diesel informal including the fields. These large vessel informa who is refractory to the first line therapy or who has relapse uh within 12 months of uh first line of therapy. And the current study presented is the long term survival follow ups of this uh study and basically show that a median follow up of uh close to four years. And the car T cells XSL as the second line treatment for patient was early relapse, refractory large B cell lymphoma result in significant longer overall survival than the traditional standard care uh with high dose chemotherapy and autologous stem cell transplant. The survivor advantage is uh uh 30 is uh not reached in the medium over, it's about not reaching the car T cell group. And the 31 months in the standard care group was uh estimate four year over. So I will 55% compared to 46%. And uh this difference reached stated to go significance with the P value 460.3. So this is basically a practice changing result suggests that for the old patient was early relapsed, diffuse large B cell lymphoma or uh probably refractory, they should be receiving car T cell therapy with overall survival advantage. Uh So that's what I might take is from Pasco and welcome any questions you have. Uh Doctor Lin. Thank you so much for a really comprehensive understanding of uh stem cell transplantation in older older patient's really quick summary of the high level papers, uh Osco and an insight into what we should be expecting to see in, in the coming years in care, particularly of, of the older patient. Uh Thank you so much for your time. We're really grateful and uh and we appreciate you giving us such a really great summary today. I'm sure there would be a ton of questions from the audience who are listening and we'll pass them straight straight onto you. Thank you so much. OK. Thank you. It was nice meeting you guys. Well.