18th Congress of EHA

Age and ageing in blood disorders

Prof Pieter Sonneveld - University Hospital Rotterdam, Netherlands

Dr Sonneveld, welcome to the ecancer studio here in Stockholm. Does your interest in age and aging in blood disorders imply that older patients with such disorders have a poorer prognosis or worse therapeutic outcomes than younger patients?

Yes, well there are several issues related to age and aging in blood disorders. The first one you are addressing right now, I’ll come back to that, but it’s also the fact that at a higher age people are more likely to get cancer, including leukaemias and other blood cancers. So that’s one and the other one is that patients that are already known with a blood disorder, when they age they are more likely to develop additional symptoms and problems related to that disease. And aging cells in our body, this is true for all systems in our body, usually are functionally impaired or get functionally impaired. So this brings additional problems in people who have blood diseases and, again, those aging cells are more likely to get DNA defects, mutations, things like that which will or may result in a blood disorder.

So once the blood disease or the blood cancer is there at a higher age it’s also more difficult to treat or to cure. So older patients with blood cancers like leukaemia, lymphoma, myeloma, they need a special approach. We cannot do a bone marrow transplant, we cannot do highly intensive regimens in those patients so they need a more age-adapted treatment approach.

Is it fair to say, then, that elderly patients are unrepresented, relatively speaking, in clinical trials?

Absolutely. In many clinical trials the majority of patients are younger patients because there are so many exclusion criteria that the older patients are automatically excluded or not even looked for in the clinical trials. In a few diseases like lymphoma and multiple myeloma special trials have been designed for patients over 65 or 70 aiming at trying to improve the prognosis in that specific age group. But generally speaking there is nothing of attention for this age problem.

And as far as practising haematologists are concerned, do they recognise the extent of this problem?

The majority of patients that they see in their clinics are older patients so for them it’s daily life. So it’s an unmet medical need, you could say, for proper regimens and treatment approaches in the older age population.

So what are you and your colleagues doing to address this dilemma and is there anything that has been presented at this meeting that indicates that some progress is being made?

Yes, I think the progress that is being made is that we recognise that older patients represent a large group of patients with blood cancers, that they need a specific approach and the approach in some diseases should not be aiming at cure, rather should aim at care for the patients. Control the disease, look after the patients’ quality of life, see to it that the patient has a couple of years of good quality of life, relatively good quality of life where he can live with the disease rather than that we push to the end to eliminate the disease when we know it’s in fact not possible.

So to some extent it is realising, recognising that therapeutic interventions that may be applicable to younger patients simply don’t work in the elderly population.

Yes and no. Yes, in a way that the novel drugs that are now becoming available for myeloma and other diseases, that we should also use those in the older patients; that combinations of drugs generally work better also in older patients but dosing and scheduling may be different in the older patients. So in a way that they can tolerate the treatment, that they are able to complete the treatment as it was designed so that they don’t discontinue prematurely and this will result in a better overall outcome for the older patients. So rather than giving a drug twice a week you can also do it once weekly and see to it that patients really complete the treatment that they need to control the disease.

Dr Sonneveld, thank you very much indeed.