Hematopoietic stem cell transplantation can be a life-saving treatment for people with blood cancer. But some people are too old or weak to withstand the harsh “conditioning” regimen necessary to kill the diseased cells before transplantation. Some are also more likely to experience serious complications like graft-versus-host disease, or GVHD. This is especially true of older patients or those with underlying health conditions. However, age alone does not provide accurate or reliable enough information about an individual’s ability to withstand transplantation.
At Fred Hutch, researchers have developed risk-assessment tools to better predict survival after hematopoietic cell transplants for patients with acute myeloid leukemia, or AML. The tool helps doctors and patients refine decision-making about the modality and intensity of therapy for AML patients. Our current research aims at assessing the best treatment options to increase quality of life for older and more infirm patients with AML.
Reliable Prediction Tools
Acute myeloid leukemia AML is an aggressive, life-threatening disease whose risk increases with age. However, AML patients aged 60 and survive for shorter periods after diagnosis compared to younger patients due, in part, to less aggressive treatment of their leukemia.
Physicians may not recommend intensive, potentially curative treatment, because they believe their patients may die from the treatment itself. Physicians are even reluctant to offer minimally toxic chemotherapy regimens to their older patients, instead using an arbitrary age cutoff, such as 60 or 70 years, to decide how to treat the AML.
However, age alone is not an accurate measure for risk assessment, since older patients can be healthier than younger patients, depending on other health factors. Organ dysfunctions, for example, are likely more relevant than age in determining how patients will tolerate treatment.
Based on the commonly used Charlson Comorbidity Index, Dr. Mohammed Sorror and his colleagues at Fred Hutch developed the first scoring system, now used worldwide, that reliably predicts the outcome in transplant patients. More recently, they have developed a more refined assessment measure, specifically for AML patients.
The Hematopoietic Cell Transplant Comorbidity Index (HCT-CI)
- Developed in 2005, this novel tool takes into account the specific needs of the transplant population, such as infections and organ function.
- The tool assimilates the effect of 17 medical conditions and summarizes them into a score that predicts the survival of transplant patients as well as the risk of acute graft-versus-host disease, a serious complication of transplantation.
The AML-Composite Model
- Developed in 2017, this tool combines the HCT-CI with information on the genetics of the patient’s AML to create an AML-specific assessment tool.
- This tool can give older patients hope, if they are likely to benefit from curative transplantation therapy or spare them unnecessary toxicity and cost if they are not.
AML Composite Model: Prepare for Success
For Physicians and Patients
Physician Information
Find more information on using our assessment tools to better determine outcomes for older patients with AML.
Patient Information
Find information for your doctor or learn more about our clinical trials to improve outcomes and quality of life for older patients with AML.
Short-Term Training Opportunities
Under the mentorship of the Staff Scientist and Project Coordinator, the Clinical Research Intern will assist with tasks throughout the entire research process, including:
- Assist in developing and compiling documents and materials necessary for recruitment and consenting of research subjects and to help track each project’s progress.
- Help manage, transcribe, and analyze survey data collected from ongoing research projects. This will include verifying the accuracy of research study data, preparing data for computer input, recording data in research database files and data spreadsheets, generating summary statistics of the data, and providing assistance with writing and preparation of main study findings.
- Learn how to perform various research support functions, including note-taking during meetings, transcribing and proofreading research documents (e.g. dictation for journal reviews, research budget justifications), performing background literature reviews, manage and track documentation related to recruitment of research participants, and in organizing and synthesizing information related to the research process.
- Learn about clinical research in the cancer patient population and provide introductory qualitative and statistical data analysis experience.
- Develop strong verbal and written communication skills and provide the ability to gain working experience that requires a high level of detail and organizational skills.
- Attend appropriate training sessions and group meetings.
Please note that internships are unpaid six month positions requiring at least 10 hours per week.
- Ideal intern is a senior-level undergraduate student or recent college graduate.
- A high school degree is required.
- This internship is ideal for an individual interested in pursuing a career in clinical research, public health or social sciences.
Contact Jennifer Nyland at jnyland@fredhutch.org for more information.