/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. K E Y W O R D Sacute lymphoblastic leukemia, chemotherapy, elderly, epidemiology

Objectives As new, effective therapies emerge for acute lymphoblastic leukaemia (ALL), the results of clinical trials need to relate to standard of care. Methods We used the population‐based Swedish ALL Registry to evaluate characteristics, treatment and long‐term outcome in 933 patients with diagnosis between 1997 and 2015. Results The median age was 53 years. The frequency of Philadelphia (Ph)‐positive leukaemia was 34% of examined B‐ALL with a peak incidence at 50‐59 years. Five‐year overall survival (OS) improved between 1997‐2006 and 2007‐2015; in patients 18‐45 years from 50% (95% CI 43‐57) to 65% (95% CI 58‐72), 46‐65 years from 25% (95% CI 18‐32) to 46% (95% CI 37‐55) and >65 years from 7% (95% CI 2.6‐11) to 11% (95% CI 5.9‐16) (P < 0.05). Men with Ph‐neg B‐ALL 46‐65 years had inferior OS compared with women (P < 0.01). Standardised mortality ratio was 5.7 (95% CI 5.0‐6.3) for patients who survived 5 years from diagnosis. In multivariable analysis, Ph‐positive disease was not associated with impaired prognosis but with lower risk of death in 2007‐2015. Conclusions In a population‐based cohort, OS has improved in adult ALL, especially for Ph‐positive disease but for middle‐aged men with Ph‐negative B‐ALL outcome was poor. Cure without late toxicity or relapse is still desired.

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractObjectives: The use of patient-reported outcome (PRO) measured outside clinical trials is not well defined. We report the first analysis of the prospective PRO study within the Swedish acute myeloid leukemia (AML) and the acute lymphoblastic leukemia (ALL) registries. Methods: PRO was requested 6 months after diagnosis. The EORTC Quality of life Questionnaire Core 30-item, the Patient Health Questionnaire-8 (PHQ-8), and questions from a Swedish National Cancer Questionnaire were used.Results: An invitation letter was sent to 398 patients; 255 (64%) responded, 60% web-based, and 40% on paper. The ALL cohort had lower physical, role and social functioning, higher symptom burden, and more financial difficulties compared to the AML cohort. A PHQ-8 score ≥ 10p, which indicates depression, was reported in 18% of the patients; 33% of these patients reported being prescribed antidepressants. The patients' overall experience of care was satisfying, but more psychological and practical support was desired. There was no difference in survival between patients who reported their PRO and those who did not. Follow-up at 2 and 4 years is ongoing.Conclusions: PRO collected in a registry-based setting is feasible, but the selection of time points and questionnaires are delicate in a diverse patient population.

Cytogenetic aberrations are recognized as important prognostic factors in adult acute lymphoblastic leukemia (ALL), but studies seldom include elderly patients. From the population‐based Swedish ALL Registry, we identified 728 patients aged 18–95 years, who were diagnosed with ALL 1997–2015 and had cytogenetic information. Registry data were complemented with original cytogenetic reports. BCR‐ABL1 was the most recurrent aberration, with a frequency of 26%, with additional cytogenetic alterations in 64%. KTM2A rearrangement was the second most frequent aberration found in 7%. Low hypodiploidy‐near triploidy and complex karyotype had negative impact, while t(1;19);TCF3‐PBX1 showed positive impact on overall survival. However, after correction for age only complex karyotype remained significant.