Adult acute lymphoblastic leukaemia in Denmark. A national population‐based retrospective study on acute lymphoblastic leukaemia in Denmark 1998–2008

Abstract

SummarySince July 2008, children and adults 1-45 years, diagnosed with acute lymphoblastic leukaemia (ALL) in Denmark have been treated according to the common Nordic Society for Paediatric Haematology and Oncology ALL2008 protocol. To explore whether this strategy will improve survival compared with historical controls, we performed a retrospective national population-based study of adult ALL between 1998 and 2008. Patients were identified through the Danish Patobank and the Danish Cancer Registry; data was collected from patient files, and included 277 patients (median age, 47 years, range 15-91 years). The 5-year projected event-free survival (pEFS 5y ) and overall survival (pOS 5y ) for the whole cohort was 27AE5% [95% confidence interval (CI) 22AE4-33AE6] and 34AE1% (95% CI 28AE7-40AE4), respectively. No patient above 65 years survived beyond 5 years from diagnosis. For patients receiving curatively intended treatment, the pEFS 5y and pOS 5y were 36AE6% and 44AE1%, respectively, with a significantly higher pOS 5y for patients 15-35 years compared with patients 36-65 years (50AE7% vs. 38AE9%, P = 0AE006). Cox multiple regression analysis identified age (Hazard Ratio = 1AE7, P < 0AE006) as a statistically significant predictor of EFS. The cure rates, not least for the elderly, are unacceptably low, and call for new strategies in the treatment of adult ALL in all age groups.

Overall survival among older US adults with ALL remains low despite modest improvement since 1980: SEER analysis

“…Age at diagnosis, time period of diagnosis, known history of cancer preceding ALL diagnosis, and SEER registry region were associated with OS (supplemental Table 1 7 Other recent European registry studies have also noted 3-year OS #15% to 20% among adults with ALL age 60 to 65 years or older. [8][9][10] This study describes a greater number of patients age $60 years, confirms that OS has improved modestly (albeit significantly) in older adults since 1980, and is strengthened by multivariable analysis as noted above.…”

“…5,6 European population-based analyses have similarly revealed suboptimal outcomes in this population. [7][8][9][10] Emerging novel agents provide substantial antileukemic effect with manageable toxicity and may represent attractive therapeutic strategies for older patients with ALL, either as components of initial therapy or as treatment at relapse. [11][12][13][14][15] There remains a paucity of data reflecting clinical outcomes in older US adults with ALL, particularly outside clinical trials, which provides historical context for evaluating novel approaches.…”

Treatment of older patients with acute lymphoblastic leukemia

“…2,15,26,27 Survival rates in patients .60 years were 12% at 5 years in Northern England. 2 For those aged between 65 to 74 years, survival was 25% in Sweden where outcome further decreased to 10% in patients .74 years.…”

“…2,15,17,26,27,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] One central question is whether and/or which anthracycline has to be included in induction regimens for older patients, because these drugs contribute considerably to bone marrow toxicity. One approach is the use of idarubicin in induction, based on a potentially lower cardiac and hepatic toxicity.…”

How I treat older patients with ALL

“…Therefore, induction therapy is the most critical phase for management. In older patients, induction mortality has a wide range (0% to 42%) ( Table 1 1,4-6,11,14,15, [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] ). Seven percent to 10% of older patients die even before initiation of chemotherapy.…”