TY - JOUR
T1 - Outcomes in older adults with acute lymphoblastic leukaemia (ALL)
T2 - Results from the international MRC UKALL XII/ECOG2993 trial
AU - Sive, Jonathan I.
AU - Buck, Georgina
AU - Fielding, Adele
AU - Lazarus, Hillard M.
AU - Litzow, Mark R.
AU - Luger, Selina
AU - Marks, David I.
AU - Mcmillan, Andrew
AU - Moorman, Anthony V.
AU - Richards, Susan M.
AU - Rowe, Jacob M.
AU - Tallman, Martin S.
AU - Goldstone, Anthony H.
PY - 2012/5
Y1 - 2012/5
N2 - Although the incidence rate of acute lymphoblastic leukaemia (ALL) is slightly higher in older than in younger adults, response rates to induction chemotherapy and survival rates are poorer. The contribution of disease-related versus treatment-related factors remains unclear. We analysed 100 older patients (aged 55-65 years) treated on the UKALLXII/ECOG2993 trial compared with 1814 younger patients (aged 14-54 years). Baseline characteristics, induction chemotherapy course, infections, drug reductions and survival outcomes were compared. There were more Philadelphia-positive (Ph+) patients in the older group (28% vs. 17%, P = 0·02), and a trend towards higher combined cytogenetic risk score (46% vs. 35%, P = 0·07). The complete remission rate in older patients was worse (73% vs. 93%, P < 0·0001) as was 5-year overall survival (21% vs. 41%, P < 0·0001) and event-free survival (EFS) (19% vs. 37%, P < 0·0001). Older patients had more infections during induction (81% vs. 70%, P = 0·05), and drug reductions (46% vs. 28%, P = 0·0009). Among older patients, Ph+ and cytogenetic risk category as well as infection during induction predicted for worse EFS. Poorer outcomes in these patients are partly due to cytogenetic risk, but there is significant morbidity and mortality during induction chemotherapy with frequent delays and drug reductions. New approaches, including better risk stratification and use of targeted therapies, could improve treatment for these patients.
AB - Although the incidence rate of acute lymphoblastic leukaemia (ALL) is slightly higher in older than in younger adults, response rates to induction chemotherapy and survival rates are poorer. The contribution of disease-related versus treatment-related factors remains unclear. We analysed 100 older patients (aged 55-65 years) treated on the UKALLXII/ECOG2993 trial compared with 1814 younger patients (aged 14-54 years). Baseline characteristics, induction chemotherapy course, infections, drug reductions and survival outcomes were compared. There were more Philadelphia-positive (Ph+) patients in the older group (28% vs. 17%, P = 0·02), and a trend towards higher combined cytogenetic risk score (46% vs. 35%, P = 0·07). The complete remission rate in older patients was worse (73% vs. 93%, P < 0·0001) as was 5-year overall survival (21% vs. 41%, P < 0·0001) and event-free survival (EFS) (19% vs. 37%, P < 0·0001). Older patients had more infections during induction (81% vs. 70%, P = 0·05), and drug reductions (46% vs. 28%, P = 0·0009). Among older patients, Ph+ and cytogenetic risk category as well as infection during induction predicted for worse EFS. Poorer outcomes in these patients are partly due to cytogenetic risk, but there is significant morbidity and mortality during induction chemotherapy with frequent delays and drug reductions. New approaches, including better risk stratification and use of targeted therapies, could improve treatment for these patients.
KW - Acute lymphoblastic leukaemia
KW - Chemotherapy
KW - Elderly
KW - Infection
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U2 - 10.1111/j.1365-2141.2012.09095.x
DO - 10.1111/j.1365-2141.2012.09095.x
M3 - Article
C2 - 22409379
AN - SCOPUS:84860012521
SN - 0007-1048
VL - 157
SP - 463
EP - 471
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 4
ER -