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

SIMPLE SUMMARY: Disease-specific mortality of acute lymphoblastic leukemia (ALL) increases with age. So far, only a few analyses have investigated disease characteristics of elderly patients (>55 years) with newly diagnosed ALL. The aim of our retrospective study was to evaluate the treatment res...

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Autores principales: Wenge, Daniela V., Wethmar, Klaus, Klar, Corinna A., Kolve, Hedwig, Sauer, Tim, Angenendt, Linus, Evers, Georg, Call, Simon, Kerkhoff, Andrea, Khandanpour, Cyrus, Kessler, Torsten, Mesters, Rolf, Schliemann, Christoph, Mikesch, Jan-Henrik, Reicherts, Christian, Brüggemann, Monika, Berdel, Wolfgang E., Lenz, Georg, Stelljes, Matthias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8833618/
https://www.ncbi.nlm.nih.gov/pubmed/35158832
http://dx.doi.org/10.3390/cancers14030565
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author Wenge, Daniela V.
Wethmar, Klaus
Klar, Corinna A.
Kolve, Hedwig
Sauer, Tim
Angenendt, Linus
Evers, Georg
Call, Simon
Kerkhoff, Andrea
Khandanpour, Cyrus
Kessler, Torsten
Mesters, Rolf
Schliemann, Christoph
Mikesch, Jan-Henrik
Reicherts, Christian
Brüggemann, Monika
Berdel, Wolfgang E.
Lenz, Georg
Stelljes, Matthias
author_facet Wenge, Daniela V.
Wethmar, Klaus
Klar, Corinna A.
Kolve, Hedwig
Sauer, Tim
Angenendt, Linus
Evers, Georg
Call, Simon
Kerkhoff, Andrea
Khandanpour, Cyrus
Kessler, Torsten
Mesters, Rolf
Schliemann, Christoph
Mikesch, Jan-Henrik
Reicherts, Christian
Brüggemann, Monika
Berdel, Wolfgang E.
Lenz, Georg
Stelljes, Matthias
author_sort Wenge, Daniela V.
collection PubMed
description SIMPLE SUMMARY: Disease-specific mortality of acute lymphoblastic leukemia (ALL) increases with age. So far, only a few analyses have investigated disease characteristics of elderly patients (>55 years) with newly diagnosed ALL. The aim of our retrospective study was to evaluate the treatment results of 93 elderly patients who received intensive chemotherapy between May 2003 and October 2020. We identify poor performance status and older age at the time of diagnosis as risk factors for inferior outcomes, while ALL immunophenotype, BCR::ABL1 status, the complexity of karyotype, and intensity of treatment did not significantly affect overall survival (OS). With 17.3% of patients dying while in complete remission (CR), an event-free survival (EFS) and OS of 32.9% and 47.3% at 3 years, our data suggest that intensive treatment of elderly ALL patients is feasible but associated with significant toxicity. These results underline the need for novel, less toxic treatment approaches for this vulnerable cohort of patients. 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.
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spelling pubmed-88336182022-02-12 Characteristics and Outcome of Elderly Patients (>55 Years) with Acute Lymphoblastic Leukemia Wenge, Daniela V. Wethmar, Klaus Klar, Corinna A. Kolve, Hedwig Sauer, Tim Angenendt, Linus Evers, Georg Call, Simon Kerkhoff, Andrea Khandanpour, Cyrus Kessler, Torsten Mesters, Rolf Schliemann, Christoph Mikesch, Jan-Henrik Reicherts, Christian Brüggemann, Monika Berdel, Wolfgang E. Lenz, Georg Stelljes, Matthias Cancers (Basel) Article SIMPLE SUMMARY: Disease-specific mortality of acute lymphoblastic leukemia (ALL) increases with age. So far, only a few analyses have investigated disease characteristics of elderly patients (>55 years) with newly diagnosed ALL. The aim of our retrospective study was to evaluate the treatment results of 93 elderly patients who received intensive chemotherapy between May 2003 and October 2020. We identify poor performance status and older age at the time of diagnosis as risk factors for inferior outcomes, while ALL immunophenotype, BCR::ABL1 status, the complexity of karyotype, and intensity of treatment did not significantly affect overall survival (OS). With 17.3% of patients dying while in complete remission (CR), an event-free survival (EFS) and OS of 32.9% and 47.3% at 3 years, our data suggest that intensive treatment of elderly ALL patients is feasible but associated with significant toxicity. These results underline the need for novel, less toxic treatment approaches for this vulnerable cohort of patients. 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. MDPI 2022-01-23 /pmc/articles/PMC8833618/ /pubmed/35158832 http://dx.doi.org/10.3390/cancers14030565 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wenge, Daniela V.
Wethmar, Klaus
Klar, Corinna A.
Kolve, Hedwig
Sauer, Tim
Angenendt, Linus
Evers, Georg
Call, Simon
Kerkhoff, Andrea
Khandanpour, Cyrus
Kessler, Torsten
Mesters, Rolf
Schliemann, Christoph
Mikesch, Jan-Henrik
Reicherts, Christian
Brüggemann, Monika
Berdel, Wolfgang E.
Lenz, Georg
Stelljes, Matthias
Characteristics and Outcome of Elderly Patients (>55 Years) with Acute Lymphoblastic Leukemia
title Characteristics and Outcome of Elderly Patients (>55 Years) with Acute Lymphoblastic Leukemia
title_full Characteristics and Outcome of Elderly Patients (>55 Years) with Acute Lymphoblastic Leukemia
title_fullStr Characteristics and Outcome of Elderly Patients (>55 Years) with Acute Lymphoblastic Leukemia
title_full_unstemmed Characteristics and Outcome of Elderly Patients (>55 Years) with Acute Lymphoblastic Leukemia
title_short Characteristics and Outcome of Elderly Patients (>55 Years) with Acute Lymphoblastic Leukemia
title_sort characteristics and outcome of elderly patients (>55 years) with acute lymphoblastic leukemia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8833618/
https://www.ncbi.nlm.nih.gov/pubmed/35158832
http://dx.doi.org/10.3390/cancers14030565
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