Outcomes In Older Adults with Acute Lymphoblastic Leukemia (ALL): Results From the International MRC UKALL XII/ECOG2993 Trial

摘要

Although the incidence rate of acute lymphoblastic leukemia (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 (age-range 55–65) treated on the UKALLXII/ECOG2993 trial compared with 1814 younger patients (age-range 14–54). We compared baseline characteristics, induction chemotherapy course, infections, drug reductions and survival outcomes. There were more Philadelphia-positive (Ph+) patients in the older group (28% vs. 17%, p=0.02), and a trend in higher combined cytogenetic risk score (46% vs. 35%, p=0.07). The complete remission rate was worse (73% vs. 93%, p<0.0001) as was five-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 with 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.