Age but not Philadelphia positivity impairs outcome in older/elderly patients with acute lymphoblastic leukemia in Sweden
(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.
(Less)
- author
- Kozlowski, Piotr ; Lennmyr, Emma ; Ahlberg, Lucia ; Bernell, Per ; Hulegårdh, Erik ; Karbach, Holger ; Karlsson, Karin LU ; Tomaszewska-Toporska, Beata ; Åström, Maria and Hallböök, Heléne
- author collaboration
- organization
- publishing date
- 2017-08-01
- type
- Contribution to journal
- 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
-
- pmid:28419558
- wos:000404936400005
- scopus:85020727975
- 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
- 2024-05-12 18:18:54
@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}},
issn = {{0902-4441}},
keywords = {{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}},
doi = {{10.1111/ejh.12896}},
volume = {{99}},
year = {{2017}},
}