hematology-2018-keynote

2 / 4

Page 6
Notes:
Journal of Hematology and Blood Disorder | Volume 2
allied
academies
August 23-24, 2018 | London, UK
Hematology and Oncology
2 nd International Conference on
Currently hematopoietic cell transplantation (HCT) is the only
therapeuticmodality with proven curative potential for patients
with myelodysplastic syndrome (MDS) or myeloproliferative
neoplasms (MPN). However, HCT is associated with certain,
potentially fatal complications, such as graft versus host disease
(GVHD). As these disorders occur primarily in older individuals
who often present with comorbid conditions, a central question
is whether non-transplant therapies might be preferable
in regards both quality and quantity of life. This question is
enhanced by the recent progress in our understanding of the
genetics and pathophysiology of the hematopoietic system, and
the development of a rapidly broadening spectrum of novel
therapeutic agents, which offer a new outlook to many patients
who previously had limited treatment options. Further, the life
expectancy of patients with MDS or MPN varies greatly, from a
fewmonths to a decade or more, and it may not be appropriate
aggressive therapy up-front. Retrospective analyses of date in
MDS as well as in MPN have shown that patients with “low
risk “disease may not benefit from HCT, and comparison of
hypomethylating therapy and HCT in patients with MDS have
shownthateveninhigherriskpatientsthebenefitofHCTmaynot
become apparent for two years or more Therefore, particularly
in older individuals, a central question may be whether non-
transplant therapies might be preferable regarding the quality
and quantity of life. From a different perspective, many of
modern non-transplant therapeutics come at an exorbitant
cost, and, dependent upon the indication, prolongation of life
may only be on the order of months, and, furthermore, the gain
in comparison to results with more conventional and less costly
drugs may only be incremental. Therefore, important aspects
to be addressed by any physician treating these patients are the
patients’ own priorities including their resources, considering
the frequently considerable out-of-pocket expenses, even for
patients who do have insurance coverage. The discussions also
need to include deliberation of the optimum timing of HCT if it
is considered, If HCT is considered in very high-risk patients or
in patients who have failed other therapies, the success rate is
considerably lower than among good risk patients or patients
transplanted early in the disease course. This raises questions
as to the cost/benefit ratio and the role of the physician as a
financial steward of health resource utilization. Of course,
some might argue that in view of the cost of modern anti-
cancer drugs, HCT may look like a good deal. Thus, modern
treatment of hematologic malignancies is presenting us with
enormous challenges in regard the uncertainty of success,
the cost to the patient and to society, even though little
gain might be expected. These discussions need to involve
not only the medical community but our society at large.
Speaker Biography
H Joachim Deeg completed his MD in Wilhelms Universitaet, Germany. Presently
he is working as a Professor of medicine in the University of Washington. He is
also a member of the Fred Hutchinson Cancer Research Center. He is also a visiting
professor at Carl Carus University, Dresden, Germany. His research interests are
Pathophysiology, genetics and epigenetics of MDS (role of transcription factors
in regulation) Inflammatory responses and GVHD (effects of alpha1 anti-trypsin
[AAT]), Separation of GVHD and GVL effects by AAT, Iron and allogeneic responses.
e:
H Joachim Deeg
University of Washington, USA
Hematopoietic cell transplantation for myelodysplastic syndrome and
myeloproliferative neoplasms: issues of age, ethics, and uncertainty