Optimal management of adults with ALL

Abstract

SummaryThe cure rate of acute lymphoblastic leukaemia (ALL) in adults remains unsatisfactory. The remarkable progress in childhood ALL has not been replicated in adult ALL and approximately two thirds of patients younger than 60 years, and more than 90% of those over 60 years, are expected to succumb to their disease. Over 80% of adults can achieve a complete remission; however, the majority of such patients relapse. Nevertheless, significant developments have occurred over the past decade. Prognostic factors have been more clearly defined, moving cytogenetics and molecular determinants forefront, much like acute myeloid leukaemia. Studies of postremission therapy have included prospective evaluation of allogeneic transplantation in areas not previously evaluated, i.e. patients with standard risk. Most importantly, the advent of imatinib mesylate has changed the outlook for adults with Ph-positive ALL. Much work needs to be done to further improve chemotherapy treatment and reduce the toxicity of transplants.

Influence of age on outcome after allogeneic hematopoietic cell transplantation: a single center study in patients aged ⩾60

“…3 The negative impact of age ⩾ 60 years was also reported in patients with Non-Hodgkin-lymphoma, ALL and Hodgkin lymphoma. [4][5][6][7] Among the reasons for the inferior survival in elderly patients are increased chemotherapy-related toxicities and adverse disease biology. 8 The introduction of reduced intensity conditioning (RIC) regimens in allogeneic HCT allows the use of this treatment even in older, comorbid or heavily pretreated patients and therefore enables a curative therapeutic option in patients who are not the candidates for HCT using a myeloablative conditioning.…”

Transplantation in adult ALL

“…In adult ALL, the overall complete remission (CR) rate of 85% to 90% is very high 3,[5][6][7] and confirms the efficacy of induction regimens with relatively low toxicity, which allow a very high percentage of patients to receive postremission therapy. Therefore, the problem with this disease is relapsing from remission, despite the fact that, as in pediatric ALL, the treatment is initially very intensive throughout induction and consolidation, and the maintenance treatment typically goes on for an additional 2 years or more.…”

Intensive chemotherapy to improve outcome in patients with acute lymphoblastic leukemia over the age of 40: a phase II study for efficacy and feasibility by HOVON

“…Rowe reported that long-term survival after intensive chemotherapy in patients over 60 was B10%. 7 This was Abbreviation: DFS, disease-free survival; EFS, event-free survival; OS, overall survival; SCT, stem cell transplantation. a Mentioned here are patients who received the therapy according to protocol, that is, within predefined time frames; many patients got the treatment with delay (see also 'off therapy due to delay' and 'of whom definitively' in the next row); all together, 20 patients received allogeneic SCT (allo-SCT) and 21 received maintenance therapy.…”