ESH AL 2018 | The impact of age in Ph+ and Ph-like ALL

We live in countries where the median life expectancy has extremely advanced and growing consistently, I mean in Italy, the median life expectancy of women is around 85 years. Men obviously lagging behind, but they’ve tipped over eighty. I always tell our young generation of hematologists that if you reach the age of 70, your mean life expectancy is another 20 years, because they’re selected to live longer simply because you haven’t died before it’s obvious this but people don’t think about that, so you can’t tell a 75 year old that you’re not going to work him up correctly, this unacceptable today.
And this applies in acute leukemia maybe less, although I gave an example of one disease where you have to do all the testing, but think about other diseases: chronic lymphocytic leukemia, lymphoma, myeloma; we have to do all this. So, we have to put together accurate diagnosis independent of age, rapid, and the prognostic certification which is based on biology. Then obviously in the choice of treatment, we put all these biological parameters together plus performance status, comorbidities, but having so many drugs now and so many targeted drugs has changed completely, it’s not only chemotherapy which is not really doable if it’s aggressive chemo in the elderly, now we have a variety of drugs for many conditions, so I think the scenarios set is changing dramatically.
What is very close to me and I’m also concerned of this, is that the world is very vast, I mean you’re talking about the lucky few, I mean we’re talking formerly before of India or think about China, I mean two small countries that have about half of the population the world, I mean all these patients in rural areas, do these countries even diagnose or are they managed appropriately? I don’t think so to be very honest, so these are very practical problems. Philadelphia positive ALL is an example of a disease where with a simple molecular testing and the pill, we’re given no intravenous, (just the) pill, you can control the disease, so I think the practical example of how we should be performing, and unfortunately this is becoming very difficult, particularly the cost of everything, I mean cost of testing and of drugs is becoming very expensive so it’s becoming a major issue. Well, the bottom line is that if you’re wealthy, you will manage. If you can’t afford it, it’s going to become very difficult, that is the bottom line.