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Age but not Philadelphia positivity impairs outcome in older/elderly patients with acute lymphoblastic leukemia in Sweden

Kozlowski, Piotr; Lennmyr, Emma; Ahlberg, Lucia; Bernell, Per; Hulegårdh, Erik; Karbach, Holger; Karlsson, Karin LU ; Tomaszewska-Toporska, Beata; Åström, Maria and Hallböök, Heléne, et al. (2017) In European Journal of Haematology 99(2). p.141-149
Abstract

Objectives: Older/elderly patients with acute lymphoblastic leukemia (ALL) are poorly represented in clinical trials. Methods: Using Swedish national leukemia registries, we investigated disease/patient characteristics, treatment choices, outcome, and the impact of an age-adapted protocol (introduced in 2009) in this population-based study of patients aged 55-85 years, diagnosed with ALL 2005-2012. Results: Of 174 patients, 82% had B-phenotype, 11% Burkitt leukemia (excluded), and 7% T-phenotype. Philadelphia chromosome positivity (Ph+) occurred in 35%. Of the 155 B- and T-ALL patients, 80% were treated with intensive protocols, and 20% with a palliative approach. Higher age and WHO performance status ≥2 influenced the choice of... (More)

Objectives: Older/elderly patients with acute lymphoblastic leukemia (ALL) are poorly represented in clinical trials. Methods: Using Swedish national leukemia registries, we investigated disease/patient characteristics, treatment choices, outcome, and the impact of an age-adapted protocol (introduced in 2009) in this population-based study of patients aged 55-85 years, diagnosed with ALL 2005-2012. Results: Of 174 patients, 82% had B-phenotype, 11% Burkitt leukemia (excluded), and 7% T-phenotype. Philadelphia chromosome positivity (Ph+) occurred in 35%. Of the 155 B- and T-ALL patients, 80% were treated with intensive protocols, and 20% with a palliative approach. Higher age and WHO performance status ≥2 influenced the choice of palliation. Intensive, palliative, and both approaches resulted in complete remission rate 83/16/70% and 3-year overall survival (OS) 32/3/26%. The age-adapted protocol did not improve outcome. With intensive treatment, platelet count ≤35×109/L and age ≥75 years were adverse prognostic factors for OS, Ph+ was not. Male sex was an adverse prognostic factor in the 55-64 year age-group. Conclusions: We report a high frequency of Ph+ in older/elderly patients, with no evidence of poorer outcome compared to Ph-negative disease. Overall prognosis for elderly patients with ALL remains dismal, despite the use of age-adapted treatment.

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publication status
published
subject
keywords
acute lymphoblastic leukemia, chemotherapy, elderly, epidemiology
in
European Journal of Haematology
volume
99
issue
2
pages
9 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:85020727975
  • wos:000404936400005
ISSN
0902-4441
DOI
10.1111/ejh.12896
language
English
LU publication?
yes
id
1c2442a1-d424-4c9c-bbc4-c11ca2bd5fd4
date added to LUP
2017-08-02 10:13:42
date last changed
2017-09-18 11:40:46
@article{1c2442a1-d424-4c9c-bbc4-c11ca2bd5fd4,
  abstract     = {<p>Objectives: Older/elderly patients with acute lymphoblastic leukemia (ALL) are poorly represented in clinical trials. Methods: Using Swedish national leukemia registries, we investigated disease/patient characteristics, treatment choices, outcome, and the impact of an age-adapted protocol (introduced in 2009) in this population-based study of patients aged 55-85 years, diagnosed with ALL 2005-2012. Results: Of 174 patients, 82% had B-phenotype, 11% Burkitt leukemia (excluded), and 7% T-phenotype. Philadelphia chromosome positivity (Ph+) occurred in 35%. Of the 155 B- and T-ALL patients, 80% were treated with intensive protocols, and 20% with a palliative approach. Higher age and WHO performance status ≥2 influenced the choice of palliation. Intensive, palliative, and both approaches resulted in complete remission rate 83/16/70% and 3-year overall survival (OS) 32/3/26%. The age-adapted protocol did not improve outcome. With intensive treatment, platelet count ≤35×10<sup>9</sup>/L and age ≥75 years were adverse prognostic factors for OS, Ph+ was not. Male sex was an adverse prognostic factor in the 55-64 year age-group. Conclusions: We report a high frequency of Ph+ in older/elderly patients, with no evidence of poorer outcome compared to Ph-negative disease. Overall prognosis for elderly patients with ALL remains dismal, despite the use of age-adapted treatment.</p>},
  author       = {Kozlowski, Piotr and Lennmyr, Emma and Ahlberg, Lucia and Bernell, Per and Hulegårdh, Erik and Karbach, Holger and Karlsson, Karin and Tomaszewska-Toporska, Beata and Åström, Maria and Hallböök, Heléne and , },
  issn         = {0902-4441},
  keyword      = {acute lymphoblastic leukemia,chemotherapy,elderly,epidemiology},
  language     = {eng},
  month        = {08},
  number       = {2},
  pages        = {141--149},
  publisher    = {Wiley-Blackwell},
  series       = {European Journal of Haematology},
  title        = {Age but not Philadelphia positivity impairs outcome in older/elderly patients with acute lymphoblastic leukemia in Sweden},
  url          = {http://dx.doi.org/10.1111/ejh.12896},
  volume       = {99},
  year         = {2017},
}