How is AML therapy changed based on fitness status?

One of the things that when we talk about AML and the elderly, and I don't want to offend anyone, because you know, elderly is, you know, we consider in this disease 65 and up, but that doesn't mean anything. But what I would say is, every time I meet someone, I tell them age isn't what determines what you can get or what your treatment course is. It is never age. Your age does not impact your fitness status. I have, you know, 80 year old patients who are out working out every single day, and I have 65 year old patients who, you know, are in a wheelchair and unable to really move around. It really does vary greatly, especially when we start talking about folks as we get a little bit old. So that does also impact the therapy in terms of the AML. So when we start talking about treatment for AML, you know, I think that there was a really study, it's getting old now, about 10 years ago, where they looked at older folks with AML. And AML is a disease of age. The average age of a patient with AML is seven years old at diagnosis. So this is absolutely, you know, our biggest population. And what they found was that over half of them were not offered treatment for their AML because their doctor felt like that there wasn't any treatments available. And that is because 30 years ago, all we had was really intensive chemotherapy, and that is what the doctors think of. They think of, oh, I remember when I was in training and these folks got so sick and the 30 year olds were getting really sick and there's nothing we could do. And it's just, you know, this is something we'll just offer hospitals. Well, there's two things that go along with that. Number one, we have a ton of new treatments and new things being, you know, basically released every day. Honestly, we had, you know, multiple new drugs approved last year that are all less intensive and more focused. So we have a great ability to impact disease. Number two, we know that when you look at patients treating the disease, especially with lower impact therapies, is better than not treating just for quality of life. Even if you weren't going for cure, treat, people live longer and have a much better quality of life if you treat, especially with these lower intensity therapies than if you don't. And so that's one of the things that's the most disturbing about this idea that folks are not being offered therapies that we know folks are going to do well. And the last piece is the therapies have come along. And one of the things I tell folks when I meet them the first time is that on the vast majority of patients, I'm going for cure for everyone. You know, I do not have an upper age range for transplant, which is the only curative therapy in this disease. What I have is an upper physical range for transplant. You have to be physically fit enough. Having said that, I met a gentleman who was 80 years old. He likes me telling the story. It's not not an issue, but he likes what he was 79 years old when I met and I talked to him and he had a new diagnosis of AMO. And we put him on a lower intensity therapy and got him into remission. And then we were discussing what do we do now if we do maintenance therapy? You know, usually the maintenance therapies will work for a year or two. And then we try to figure out what the next step is, or we could go for cure with a transplant. And he looked at me and he said, you know, my grandmother lived in 96. My great grandma lives 97. And my mom is, you know, lived in 95 because I want to outlive them all. And he played golf every day. He works out every day. We, you know, kind of did all the testing and he was really physically fit. And we we ended up taking him to transplant. He was actually the oldest patient we've transplanted here so far. I spoke to him recently. He's 83 years old. He's going to the gym every day and he feels fantastic. And theoretically, he is cured. You know, there's still a small chance, but theoretically, he has less than 10 percent chance of ever dealing with his disease again. That's a success story as we look at those are the things that we want. And I think that it's not the answer for everyone. But at the same time, there are so many different therapies, especially in this population, that we, you know, I think that our goal is to at least kind of be able to discuss it with everyone. I think that that's the thing that, you know, I always want to get out there is that, you know, again, I think that these diseases have come a long way in 20 years, especially in AML. But we have so many new therapies and less intense therapies, things that can be done outpatient, things that can be done not in the hospital, things you can, you know, you know, there was just the very first pill of, you know, just no IV therapy at all for AML approved this year. So we are, you know, kind of rapidly moving in that direction and being able to put more people in remission, better quality of life, and then for a certain amount of people, curing them. The biggest concern I have when it comes to AML patients, actually, when we start talking about folks that are elderly, if you're 30 years old, they are probably going to send you to a big center like us or Chapel Hill or Duke or MD Anderson or one of the big centers, you will see one of us, right? If you were 70 years old, unfortunately, what we found when we look at the databases around the country is that a lot of those folks are not being referred to the centers, that it is not the same algorithm because, again, this idea that how you treat AML is with incredibly intensive chemotherapy, this how we used to do it 20 to 30 years ago. I think that it is incredibly important for folks that are over the age of 60 to be seen by a leukemia specialist and at a tertiary care center, at a place that only, where you see a physician that only sees leukemia. At a certain point, this is such a rare and complicated disease that it really only needs to be treated by folks who are, who do it every day.