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Age but not Philadelphia positivity impairs outcome in older/elderly patients with acute lymphoblastic leukemia in Sweden
Örebro University, School of Health Sciences.ORCID iD: 0000-0002-0283-4418
Dept of Medical Sciences, Uppsala University, Uppsala, sweden.
University Hospital of Linköping, Linköping, sweden.
Div of Hematology, Dept of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm.
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2017 (English)In: European Journal of Haematology, ISSN 0902-4441, E-ISSN 1600-0609, Vol. 99, no 2, 141-149 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Older/elderly patients with acute lymphoblastic leukemia (ALL) are poorly represented in clinical trials.

METHODS: Using Swedish national leukemia registries, we investigated disease/patient characteristics, treatment choices, outcome, and the impact of an age-adapted protocol (introduced in 2009) in this population-based study of patients aged 55-85 years, diagnosed with ALL 2005-2012.

RESULTS: Of 174 patients, 82% had B-phenotype, 11% Burkitt leukemia (excluded), and 7% T-phenotype. Philadelphia chromosome positivity (Ph+) occurred in 35%. Of the 155 B- and T- ALL patients, 80% were treated with intensive protocols, and 20% with a palliative approach. Higher age and WHO performance status ≥2 influenced the choice of palliation. Intensive, palliative, and both approaches, resulted in complete remission rate 83/16/70%, and 3 year overall survival (OS) 32/3/26%. The age-adapted protocol did not improve outcome. With intensive treatment, platelet count ≤35 × 10(9) /L, and age ≥75 years were adverse prognostic factors for OS, Ph+ was not. Male sex was an adverse prognostic factor in the 55-64 year group.

CONCLUSIONS: We report a high frequency of Ph+ in older/elderly patients, with no evidence of poorer outcome compared to Ph negative disease. Overall prognosis for elderly patients with ALL remains dismal, despite the use of age-adapted treatment. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2017. Vol. 99, no 2, 141-149 p.
Keyword [en]
acute lymphoblastic leukemia, chemotherapy, elderly, epidemiology
National Category
Hematology
Identifiers
URN: urn:nbn:se:oru:diva-57317DOI: 10.1111/ejh.12896ISI: 000404936400005PubMedID: 28419558Scopus ID: 2-s2.0-85020727975OAI: oai:DiVA.org:oru-57317DiVA: diva2:1103726
Note

Funding Agencies:

Research Committee of Region Orebro County Council (Orebro/Sweden)  

Lions Cancer Foundation (Uppsala/Sweden) 

Available from: 2017-05-30 Created: 2017-05-30 Last updated: 2017-09-18Bibliographically approved

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Kozlowski, PiotrÅström, Maria

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