Improved outcomes in elderly patients with acute lymphoblastic leukaemia using a paediatric-based protocol-A prospective study.

Abstract

Population data have shown that the prognosis for elderly patients with acute lymphoblastic leukaemia (ALL) is poor, even in the modern era and despite improvements in the outcome for younger patients. In this Norwegian prospective population-based study, the feasibility and effectiveness of a paediatric-based regimen in newly diagnosed patients above 65 years of age with ALL were assessed. Patients who were Philadelphia chromosome (Ph) negative were assigned to unmodified doses of pegylated asparaginase starting on day 30, while Ph-positive patients were treated with imatinib. For frail patients, dose reductions were allowed at the discretion of the treating physician. A total of 52 patients were enrolled, 32 of whom were Ph negative. The median age was 70 years (range 65-82). Forty-nine attained remission, of which four did not receive further treatment and died. Six patients died while in remission and three died from a second malignancy. Among the remaining 36 patients, only six relapsed. The 2-year and 5-year overall survival rates, with a median follow-up of 3.2 years (Interquartile range 1.3-6.3), were 0.60 (95% confidence interval 0.46-0.74) and 0.50 (0.34-0.66) respectively. In conclusion, this paediatric-based protocol was well tolerated and effective, with low relapse rates and 50% long-term survival.