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Updated: May 7, 2026
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
Treatment of elderly patients with acute lymphoblastic leukaemia using a paediatric-based protocol
Marc Poch Martell1, Eshetu G Atenafu, Mark D Minden
1Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
Insights
This study found a modified pediatric-based chemotherapy regimen to be feasible for elderly patients with acute lymphoblastic leukemia (ALL). While survival improved compared to previous studies, further toxicity reduction is needed for better outcomes in this age group.
Area of Science:
- Hematology
- Oncology
- Clinical Trials
Background:
- Elderly patients (60-79 years) with acute lymphoblastic leukemia (ALL) often face poor prognoses with standard chemotherapy.
- Paediatric-based regimens have shown promise but require modification for older adults due to toxicity concerns.
Purpose of the Study:
- To evaluate the feasibility and efficacy of a modified paediatric-based chemotherapy regimen in newly diagnosed elderly patients with ALL.
- To assess treatment response, survival rates, and toxicity in this specific patient population.
Main Methods:
- Retrospective analysis of 51 elderly ALL patients (median age 65) treated with a 7-year modified paediatric-based regimen.
- Regimen included induction, CNS prophylaxis, intensification (with asparaginase or imatinib based on BCR-ABL1 status), and maintenance.
- Post-remission therapy administered in an outpatient setting.
Main Results:
- Complete response rate was 75%, with 20% induction mortality and 6% resistant disease.
- Estimated 5-year overall survival was 40% (BCR-ABL1 negative) and 47% (BCR-ABL1 positive).
- The post-induction phase was well-tolerated; 81% completed intensification and proceeded to maintenance.
Conclusions:
- The modified paediatric-based protocol is feasible and active in elderly ALL patients, showing improved survival compared to prior series.
- However, outcomes remain inferior to younger patients, highlighting the need to improve the toxicity profile, especially during induction.
- Further research should focus on optimizing treatment to enhance survival and reduce adverse events in this demographic.
Abstract:
All newly diagnosed patients aged 60-79 years with acute lymphoblastic leukaemia (ALL) receiving induction chemotherapy with a modified paediatric-based regimen over a 7-year period were retrospectively analysed (n = 51, median age 65 years). The treatment regimen consisted of induction, central nervous system prophylaxis, seven cycles of intensification and 24 cycles of maintenance. BCR-ABL1 negative patients received weekly asparaginase during intensification, while BCR-ABL1+ patients received daily imatinib. Post-remission therapy was given in an outpatient setting. The complete response rate was 75%, with an induction mortality of 20%; 6% of patients had resistant disease. 37% of patients who achieved a complete remission relapsed. The estimated 5-year overall survival was 40% for BCR-ABL1 negative and 47% for BCR-ABL1+ patients (P = not significant); the 5-year disease-free survival was 57% and 39%, respectively (P = NS). The post-induction phase was generally well tolerated, with 81% able to complete the intensification phase and proceed to maintenance. In conclusion, administration of this modified paediatric-based protocol is feasible and active for elderly patients with ALL. Survival is superior to most previously reported series in this age group, but remains worse compared to younger patients. Further improvement of the toxicity profile, particularly during induction, is required to improve outcomes.
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