Blood Cancer in the Elderly: European Expert Forum, Rome, 19—20 March 2011

Professor Francesc Solé (Hospital del Mar, Barcelona, Spain)

Parameters for diagnosing MDS

It is my privilege to be here in Rome for the European Expert Forum on Blood Cancer in the Elderly. One of the important aspects of course is myelodysplastic syndrome. Professor Solé, what is your issue here? Some patients will be at great risk of progression, others not, and genetics, you were saying I believe, seems to be rather crucial and very important.

Yes, I think that MDS is a haematological disorder associated with genetic change and the genetic changes are the most important parameters that predict which patients will respond and will not respond to the therapies and in which patients the disease will be more aggressive or less aggressive. The genetic change will define what will be the course of the patient.

You can use gene arrays, of course, but you could also use cytogenetics. How does a practising doctor get at this whole issue?

I think that cytogenetics is still the gold standard and in my opinion will be the gold standard for a long time. But now we have different techniques such as microarrays and next generation sequencing that will complement cytogenetics, will be technique complementaries. One technique will not substitute the other, all will be techniques that we have to work together.

Patients of course have clinical variables, but how important are the genetic changes that you are now talking about?

At this moment I demonstrated in a large area of cases that the cytogenetic change is the most important parameter that predicts prognosis in these patients.

And what should ordinary doctors be doing about this?

They have to ask for the genetic test on these patients and to know the prognosis impact of having   one gene involved or the other gene involved and now we start to have different treatments in relation to the genetic changes that the patients have.

What sorts of tests and what sorts of markers are available?

Now we have chromosomal markers that could be detected by cytogenetics and now we start to have genetic change, mutated genes that could be studied by molecular genetics or by sequencing. But I think we have to use chromosomal changes and genetic changes to have the information of all types of changes.

How easy it for clinicians to bring some of these tests into daily practice?

Well I think the problem is not for clinicians, the problem is to have good labs working with the clinicians, good labs that can do these techniques very well and can offer good results in a good period of time. And then the clinician has to know the clinical implications of having one gene or the other involved.

And what might be the practical benefits in terms of outcomes for a typical MDS patient?

I think the future of the correlation of answers will be to have one genetic change and one treatment against this genetic change. And now in MDS you have different genetic changes associated with different treatments. In the future all cancers will have treatments specific for the genetic change.

But you are saying you have to work together with all clinicians and all variables need to be considered. But the new markers of course, and the existing markers and the new markers are important; what new markers are on the way that could indeed help the clinician?

I think now in MDS we have five or six genes that are important for the diagnosis of MDS. The problem is that we still do not use these markers because we do not know the prognosis very well of these markers. I think in the future we will know much better about the prognosis of these markers, and if in the future there is one treatment against these markers, then the clinician will have more information to treat patients. They will have to spend more money to make a better diagnosis and then we will spend less money in treatments, and we have to treat patients that need to be treated, not to treat all patients with expensive therapy.

At the MDS session here in Rome you are talking about diagnosis of the elderly and the very elderly. How is that important and what are the differences between the very elderly and the elderly, and any other patient with MDS?

I don’t think it is important the difference between elderly and very elderly. When I received the invitation to do this talk, I was wondering to know the definition of elderly and very elderly, and elderly in the last century was any age after 50. Now it is any age after 60, and I think that in the next century it will be any age perhaps after 70 or 80. It is important to know that there are two types of end years; the periodic end years in patients less than 60 and for other patients who are elderly that means more than 50 or 60 years, but I think with reference to patients who are more than 60 or more than 70 it is not important. If you are older then the prognosis of your disease is always worse; it is age related.

So we are here together at this meeting on Blood Cancers in Elderly Patients, why is it important to have MDS discussed here and what are the benefits of addressing specifically the issue in elderly patients?

Well I think that in most of the cancers, the cancer is caused by the age of the patients. The thing is that if all of us live 150 years, all of us will have one cancer. Cancer is a disease of elderly persons so for these reasons this disease is important.

And finally, what would you say to recommend to clinicians about their actions in every day practice for MDS?

Well in my opinion what they are doing is correct. Now they are doing a very good diagnosis, doing an integrated diagnosis with the clinical data, using cytological data and genetic data. With all this information the patient will be better diagnosed, and the patient who is better diagnosed could be better treated, and better treated means correlations. That is important.

Professor Solé, it has been a great pleasure to talk with you here and I look forward to hearing much more about your genetic tests. Thank you for being on ecancer.tv.

Thank you very much.