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Improved outcomes in elderly patients with acute lymphoblastic leukaemia using a paediatric-based protocol-A
P Quist-Paulsen1, L Horvei2,3, J Dalgaard4
1Department of Hematology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
Insights
A paediatric-based regimen shows promise for elderly acute lymphoblastic leukaemia (ALL) patients over 65. This approach demonstrated effectiveness and tolerability, achieving a 50% long-term survival rate in a Norwegian study.
Area of Science:
- Hematology
- Oncology
- Geriatrics
Background:
- Elderly patients with acute lymphoblastic leukaemia (ALL) have a historically poor prognosis.
- Improvements in ALL outcomes for younger patients have not translated equally to the elderly population.
- There is a need for effective and tolerable treatment strategies for older adults with ALL.
Purpose of the Study:
- To assess the feasibility and effectiveness of a paediatric-based treatment regimen in newly diagnosed elderly patients (≥65 years) with ALL.
- To evaluate outcomes including remission rates, survival, and relapse in this specific patient cohort.
Main Methods:
- Prospective, population-based study conducted in Norway.
- Patients received a paediatric-based regimen: pegylated asparaginase for Philadelphia chromosome (Ph)-negative ALL, imatinib for Ph-positive ALL.
- Dose reductions were permitted for frail patients; treatment stratified by Ph status.
Main Results:
- 52 elderly patients with ALL were enrolled (median age 70 years).
- 49 patients achieved remission; 2-year and 5-year overall survival rates were 60% and 50%, respectively.
- Low relapse rates were observed, with only six relapses among 36 patients who did not die from other causes.
Conclusions:
- A paediatric-based protocol is well-tolerated and effective in elderly patients with newly diagnosed ALL.
- This regimen achieves favorable outcomes, including a 50% long-term survival rate and low relapse rates.
- The findings support the use of adapted paediatric protocols for managing ALL in older adults.
Abstract:
Population data have shown that the prognosis for elderly patients with acute lymphoblastic leukaemia (ALL) is poor, even in the modern era and despite improvements in the outcome for younger patients. In this Norwegian prospective population-based study, the feasibility and effectiveness of a paediatric-based regimen in newly diagnosed patients above 65 years of age with ALL were assessed. Patients who were Philadelphia chromosome (Ph) negative were assigned to unmodified doses of pegylated asparaginase starting on day 30, while Ph-positive patients were treated with imatinib. For frail patients, dose reductions were allowed at the discretion of the treating physician. A total of 52 patients were enrolled, 32 of whom were Ph negative. The median age was 70 years (range 65-82). Forty-nine attained remission, of which four did not receive further treatment and died. Six patients died while in remission and three died from a second malignancy. Among the remaining 36 patients, only six relapsed. The 2-year and 5-year overall survival rates, with a median follow-up of 3.2 years (Interquartile range 1.3-6.3), were 0.60 (95% confidence interval 0.46-0.74) and 0.50 (0.34-0.66) respectively. In conclusion, this paediatric-based protocol was well tolerated and effective, with low relapse rates and 50% long-term survival.
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