Elderly acute lymphoblastic leukemia: a Mayo Clinic study of 124 patients. Issue 4 (21st March 2019)

• Record Type: Journal Article
• Authors: Miller, Kevin C.; Al-Kali, Aref; Shah, Mithun V.; Hogan, William J.; Elliott, Michelle A.; Begna, Kebede H.; Gangat, Naseema; Patnaik, Mrinal M.; Viswanatha, David S.; He, Rong; Greipp, Patricia T.; Sproat, Lisa Z.; Foran, James M.; Litzow, Mark R.; Alkhateeb, Hassan B.
• Is Part Of: Leukemia & lymphoma. Volume 60:Issue 4(2019)
• Page Start: 990
• Page End: 999
• Publication Date: 2019-03-21
• Subjects: Elderly -- acute lymphoblastic leukemia (ALL) -- survival -- BCR-ABL1; transplant; Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.1080/10428194.2018.1509318
• Languages: English
• ISSNs: 1042-8194

Abstract

Abstract: Poor outcomes in elderly acute lymphoblastic leukemia (ALL) are well recognized, but the contributors are ill-defined. We characterized 124 patients ≥60 years old at our institution. The majority ( n = 102, 82%) were treated with intensive chemotherapy. Of these, 8/102 (8%) died within the first 100 days; 92/102 (90%) achieved complete remission (CR/CRi). Only 31/124 (25%) patients underwent allogeneic hematopoietic stem cell transplantation. The median overall survival (OS) for the entire cohort was 19.8 months. In a multivariate analysis, ECOG performance status ≥2, high white blood cell count, and high lactate dehydrogenase (at time of diagnosis) negatively influenced OS ( p <.01). In a subgroup analysis of the intensive treatment group, BCR-ABL1+ patients had markedly better OS (hazard ratio 0.3, 95% CI 0.1–0.7; p <.01). In summary, despite few early deaths and a high CR/CRi rate, elderly ALL continues to have a poor prognosis, underscoring the need for more effective therapies.