In the midst of the coronavirus pandemic, it is necessary to enhance protection for high-risk patients by embracing remote medicine and innovative therapies for AML. Prof. Arnon Nagler, Director of the Division of Hematology and Director of Bone Marrow Transplantation and Cord Blood Bank at Sheba Medical Center explains.
Acute myeloid leukemia (AML) is one of the most severe, if not the most severe, types of cancer. Most patients, even those with a good genetic profile, will not live for more than 10 years after being diagnosed with AML. Because it is such a deadly disease, it is critical to begin cancer treatment as soon as possible.
With new and advanced customized treatments, the life expectancy of AML patients and the course of the cancer can be noticeably improved. Presently, in the midst of the COVID-19 pandemic, it is these innovative therapies and the practice of remote medicine that can help protect patients with AML from the coronavirus.
Until recently, patients had two treatment options: chemotherapy and bone marrow transplantation. But both of these options are problematic for older patients. The side effects of chemotherapy can pose extreme danger. In addition, as the disease becomes more acute –chemotherapy becomes less effective. Regarding bone marrow transplantation, it is not typically suitable for elderly patients, largely out of concern that they will not comply with the procedure. Also, the average age of AML patients is about 70, making the procedure contraindicated for a significant number of people.
Now, more options are available to treat AML. In recent years, US health authorities approved eight new drugs for this use. These drugs can be administered before or after a bone marrow transplant. Sometimes, they are given while testing is done to examine how much of the disease remains after the original treatments. This method can improve the effectiveness of AML treatments and the outcome of the transplant, even in patients who are found to be at high risk for recurrence.
One of the newest types of treatment includes medications that target FLT3, a common mutation that indicates serious illness and the need for a transplant. At this point, the Israeli drug basket already includes one drug of this type, and it is expected that another drug will soon be added to the list. This additional drug, already approved for use in Europe and the US, has been scientifically proven to markedly reduce mortality rates and prolong life expectancy.
In the meantime, though, many medical professionals in the field of cancer treatment are facing challenging times. In late February and early March, two Sheba patients (age 74 and 82) under treatment for AML were lost due to infection with the novel coronavirus. As a result of their age, these patients received “low-dose” non-chemotherapy and “biological” drugs to increase the controlled killing of leukemia cells and inhibit their proliferation. As their fight against AML continued, these two elderly patients eventually died of pneumonia.
Evidence indicates that as a result of chemotherapy, immunocompromised patients are probably more susceptible to the coronavirus and may suffer more serious complications. Additionally, their chances of recovery are reduced. Therefore, recent recommendations from the European Union’s Acute Leukemia Committee for Transplantation state that as long as there is no danger of compromising the patient’s chances of recovery, lower doses of chemotherapy, non-chemotherapy treatments and outpatient treatments should be given.
Another change in the medical sector that has been gaining pace during the COVID-19 period is the widespread implementation of remote medicine. Telemedicine has been embraced both to protect higher-risk patients with comorbidities and to help prevent the entire medical system from collapse. It is expected that this technological development will likely stay with us long after the coronavirus hopefully disappears from the world.
Telemedicine is a welcome process that boosts efficiency and saves time and resources. However, it’s not without its own risks. Doctors must ensure that the use of remote medicine doesn’t harm the personal relationship between doctor and patient, as this is the real essence of medicine – for which there is no substitute. Doctors must encourage patients to stay in touch with any concerns or questions, while simultaneously practicing as much caution as possible by using remote medical options.
Over time, much has been learned about how to deal with AML, a very complex condition. But in the end, when it comes to a deadly disease that requires prompt treatment, there are few ways to circumvent patients’ high risk. Patients must take precautions to comply with every tiny detail of the Ministry of Health guidelines, because they cannot afford to become infected with the coronavirus.
This article was written in collaboration with the Association for Patient Rights, by Prof. Arnon Nagler, President of the Hemato-Oncology Center and Director of the Umbilical Cord Bank at Sheba Tel Hashomer Medical Center and Deputy Chairman of the Committee for Acute Leukemia at the European Transplant Association.