Characteristics and Outcome of Elderly Patients (>55 Years) with Acute Lymphoblastic Leukemia

Abstract

Prognosis of elderly ALL patients remains dismal. Here, we retrospectively analyzed the course of 93 patients >55 years with B-precursor (n = 88) or T-ALL (n = 5), who received age-adapted, pediatric-inspired chemotherapy regimens at our center between May 2003 and October 2020. The median age at diagnosis was 65.7 years, and surviving patients had a median follow-up of 3.7 years. CR after induction therapy was documented in 76.5%, while the rate of treatment-related death within 100 days was 6.4%. The OS of the entire cohort at 1 and 3 year(s) was 75.2% (95% CI: 66.4–84.0%) and 47.3% (95% CI: 36.8–57.7%), respectively, while the EFS at 1 and 3 years(s) was 59.0% (95% CI: 48.9–69.0%) and 32.9% (95% CI: 23.0–42.8%), respectively. At 3 years, the cumulative incidence (CI) of relapse was 48.3% (95% CI: 38.9–59.9%), and the CI rate of death in CR was 17.3% (95% CI: 10.9–27.5%). Older age and an ECOG > 2 represented risk factors for inferior OS, while BCR::ABL1 status, immunophenotype, and intensity of chemotherapy did not significantly affect OS. We conclude that intensive treatment is feasible in selected elderly ALL patients, but high rates of relapse and death in CR underline the need for novel therapeutic strategies.

Inotuzumab in Older Patients with Newly Diagnosed Acute Lymphoblastic Leukemia—A Podcast

“…Matthias Stelljes, M.D. : Older patients with ALL have historically had poor outcomes when treated with conventional chemotherapy, with 5-year survival rates of approximately 20% [ 1 – 4 ]. Numerous factors contribute to low survival rates compared to younger patients, including adverse disease biology among older patients, like high-risk genetic alterations, but the major issue is the poor tolerance to intensive chemotherapy regimens, most likely due to the presence of comorbidities, high rates of early deaths, and treatment-related mortality in remission [ 1 , 2 ].…”

“…Attempts to decrease intensity of therapy have improved treatment-related mortality, but the trade-off associated with this approach is higher rates of relapse [ 5 ]. We recently published a retrospective analysis of the course of 93 patients aged older than 55 years of age with ALL who received age-adapted, pediatric-inspired chemotherapy regimens at our center between May 2003 and October 2020 [ 4 ]. We found that intensive treatment is feasible in the selected elderly patient population, but the outcomes seemed to have improved only modestly as a conventional therapy.…”

BH3 mimetics in relapsed and refractory adult acute lymphoblastic leukemia: a Campus ALL real-life study

“…The introduction of pediatric-inspired regimens has improved outcomes remarkably in both B-cell precursor (BCP) acute lymphoblastic leukemia (ALL) and T-ALL, with 5-year overall survival rates approaching 60% in patients <55 years old 1 and between 35% and 55% in older patients. 2 Nevertheless, disease relapse and chemo-refractoriness (R/R) are still clinical problems, especially in T-ALL, for which very few novel drugs are available, and in BCP-ALL patients who fail to respond to or relapse after chemo-immunotherapy. 3 Selective inhibition of BCL-2 with venetoclax and inhibition of BCL-2 and BCL-XL with navitoclax directly releases apoptosis activators from pro-apoptotic proteins, causing permeabilization of the mitochondrial outer membrane, leading to cell death.…”

Case report: Sequential inotuzumab, blinatumomab, and chemotherapy with concurrent donor lymphocyte infusions induce complete remission in relapsed pre‐B acute lymphoblastic leukemia

“…The prognosis of relapsed or refractory (r/r) acute lymphoblastic leukemia (ALL) remains dismal to date and worsens with age [ 1 ]. 20%–40% of patients relapse after allogeneic hematopoietic cell transplantation (alloHCT), with a median overall survival (OS) of only 5.5 months [ 2 ].…”