Mylotarg vs. Stem Cell Transplant in Older Patients
Dear OncoLink "Ask The Experts,"
My mom is 69 years old and was diagnosed with AML in Nov, 2005. She has gone through two induction phases and has not been able to go into remission. The doctors say that a stem cell transplant is not an option because of her age. Her options are to go on Mylotarg or to enroll in a clinical study. My question is: does her age stop her from obtaining a STC, even though she is currently very strong and has had no past medical problems? Also, is the purpose of Mylotarg only a temporary solution to buy her some time, or have patients gone into remission with the drug for a longer period of time?
Vicki Sherry, MSN, CRNP, Advanced Practice Oncology Nurse, responds:
There are a number of issues to be addressed in this situation. Your mother is at the upper age limit for autologous stem cell transplant (donating her own cells). But, since she is not in remission, this is not an option, as those cells would not be healthy to use for transplant.
She is beyond the age limit for conventional allogeneic stem cell transplant (cells from a donor). In addition, allogeneic transplant has poor outcomes even for younger patients who have refractory leukemia. It could never be done in a patient of this age and with refractory disease.
A non-myeloablative (mini-) allogeneic stem cell transplant is designed primarily for older or sicker patients. While these transplants have resulted in long term disease-free survival in some patients - even at her age - they work very poorly in patients who are not in remission.
Therefore, currently, it does not seem that any sort of stem cell transplant is a practical option.
Mylotarg is a reasonable option to "buy time". Patients in clinical trials were able to achieve remission with this therapy. However, if it is effective, and your mom does achieve remission, she should then ask her doctor whether there would be any role for autologous stem cell transplant or non-myeloablative allogeneic stem cell transplant.
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