ACUTE LYMPHOBLASTIC LEUKEMIA IN THE ELDERLY: A TOUGH ONE

Background:

Elderly patients with acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LBL) form a special subgroup of patients with widely different outcomes.

Aims:

As higher age is usually associated with an aggressive disease course and a higher susceptibility to treatment complications, the right choice of treatment approach (intensive or palliative) is sometimes difficult. Aim of the analysis was to compare results of elderly ALL therapy using intensive regimen (Czech Leukemia Study Group protocol for ALL/LBL patients over 50 years) or palliative approach (including palliative chemotherapy).

Methods:

All patients aged over 50 years diagnosed with ALL or LBL at our centre between 2000 and 2012 were included into this retrospective analysis. We described the baseline features of these patients and treatment options used. The data were analysed for response and relapse rate, incidence of complications and risk factors affecting survival.

Results:

A total number of 59 patients aged 50 to 83 years (median age 61 years) at the time of diagnosis were included into this analysis; forty-five (76%) patients with B-ALL, five (8%) with T-ALL, six (10%) with LBL, and three (5%) patients with acute undifferentiated or biphenotypic leukemia. Median baseline leukocyte count was 10.2G/L, range 0.4-334. Nearly half of the patients carried an adverse cytogenetic or molecular marker; BCR/ABL or Philadelphia chromosome in 23 (39%), MLL fusion gene in 2 (3%), complex karyotype in 1 (2%) and other abnormalities in 5 (11%) patients. Minimal residual disease analysis was performed repeatedly in 24 patients. Intensive treatment protocol was used in 37 (63%) cases, 22 (37%) patients received palliative treatment. Hematopoietic stem cell transplantation was performed in only 5 (8%) patients. Most of the patients developed treatment complications. These were mild or moderate in 11 (19%) patients, severe or life-threatening in 34 (58%) patients and fatal in 11 (19%) cases. Forty-four (88%) out of 50 evaluable patients achieved a complete hematologic remission (CR); 97% in the intensive arm vs. 70% in the palliative arm. Complete molecular remission was reached in 33% patients; 50% in the intensive arm vs. 17% in the palliative arm. Twenty-four (55%) patients in CR eventually relapsed. During the follow-up period with a median of 8.7 months (range 0.2 to 153 months) fourty (68%) patients died. Most common causes of death were disease progression (40%), infection (33%) and non-infectious treatment toxicity (18%). Five-year progression-free (PFS) and overall survival (OS) in the whole cohort were 18% and 21%, respectively. The survival was significantly lower in patients over 65 years of age or treated using a palliative approach. In patients between the ages of 60-70 treated using our intensive protocol the survival was comparable to that observed in the age group 50-60 (5-year PFS 18% and 22%, respectively; 5-year OS 26% and 21%, respectively). The survival of patients over 70 years of age was poor, with 1-year PFS and OS of 18% and zero 2-year PFS and OS.

Summary / Conclusion:

Elderly ALL patients in the age between 50 and 60 years clearly profit from intensive treatment. Outcome of patients over 70 years of age is still poor, with no signs of improvement over time. According to our analysis, some patients in the age between 60 and 70 can benefit from intensive therapy using less toxic protocols. These patients are candidates for further analysis.

Email address: ffolber@fnbrno.cz

Keywords: Acute lymphoblastic leukemia, Chemotherapy, Elderly

Abstrakta v časopise Haematologica 2013, Suppl1

Online Program