Josep-Maria Ribera1, Olga García2, Albert Oriol2, Cristina Gil3, Pau Montesinos4, Teresa Bernal5, José González-Campos6, Esperanza Lavilla7, Jordi Ribera2, Salut Brunet8, María-Pilar Martínez9, Mar Tormo10, Eulàlia Genescà2, Pere Barba11, Josep Sarrà12, María-Carmen Monteserín13, Beatriz Soria14, Mercedes Colorado15, Antònia Cladera16, Antoni García-Guiñón17, María Calbacho18, Alfons Serrano19, Xavier Ortín20, María Pedreño21, Maria-Luz Amigo22, Lourdes Escoda23, Evarist Feliu2. 1. Hematology Department of Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute (IJC), Badalona, Universitat Autònoma de Barcelona, Spain. Electronic address: jribera@iconcologia.net. 2. Hematology Department of Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute (IJC), Badalona, Universitat Autònoma de Barcelona, Spain. 3. Hematology Department of Hospital General Universitario de Alicante, Alicante, Spain. 4. Hematology Department of Hospital Universitario y Politécnico La Fe. Valencia, Spain. 5. Hematology Department of Hospital Central de Asturias, Oviedo, Spain. 6. Hematology Department of Hospital Universitario Virgen del Rocío, Sevilla, Spain. 7. Hematology Department of Hospital Universitario Lucus Augusti, Lugo, Spain. 8. Hematology Department of Hospital de Sant Pau, Barcelona, Spain. 9. Hematology Department of Hospital Doce de Octubre, Madrid, Spain. 10. Hematology Department of Hospital Clínico, Valencia, Spain. 11. Hematology Department of Hospital Vall d'Hebron, Barcelona, Spain. 12. Hematology Department of Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Spain. 13. Hematology Department of Hospital Universitario de Getafe, Getafe, Spain. 14. Hematology Department of Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain. 15. Hematology Department of Hospital Marqués de Valdecilla, Santander, Spain. 16. Hematology Department of Hospital Son Llàtzer, Palma de Mallorca, Spain. 17. Hematology Department of Hospital Arnau de Vilanova, Lleida, Spain. 18. Hematology Department of Hospital Ramón y Cajal, Madrid, Spain. 19. Hematology Department of Hospital Madrid Norte Sanchinarro, Madrid, Spain. 20. Hematology Department of Hospital Verge de la Cinta, Tortosa, Spain. 21. Hematology Department of Hospital Universitario Doctor Peset, Valencia, Spain. 22. Hematology Department of Hospital General Universitario Morales Meseguer, Murcia, Spain. 23. Hematology Department of Institut Català d'Oncologia-Hospital Joan XXIII, Tarragona, Spain.
Abstract
BACKGROUND AND OBJECTIVE: The prognosis of acute lymphoblastic leukemia (ALL) is poor in older adults and elderly patients, and subtype-oriented prospective trials are scarce in these patients. We present the results of three prospective parallel subtype-oriented protocols in fit patients older than 55 years. PATIENTS AND METHODS: In 2008, three prospective phase II trials in patients older than 55 years were activated: ALLOLD07 for Philadephia (Ph) chromosome-negative ALL, ALLOPH07 for Ph-positive ALL, and BURKIMAB08 for mature B-ALL. Early death (ED), complete remission (CR), disease-free survival (DFS), overall survival (OS) and toxicity were analyzed. RESULTS: 56, 53 and 21 patients from the ALLOLD07, ALLOPH07 and BURKIMAB08 trials, respectively, were evaluable. CR was 74%, 87% and 70%, with an ED rate of 13%, 11% and 15%, respectively. The medians of DFS were 8 and 38 months for ALLOLD07 and ALLOPH07 protocols, not being achieved in the BURKIMAB08 trial (p=0.001), and the median OS was 12, 37 and 25 months, respectively (p=0.030). Neutropenia, thrombocytopenia and infections were less frequent in the ALLOPH07 trial vs. ALLOLD07 and BURKIMAB trials, and renal toxicity and mucositis were more frequent in the BURKIMAB08 trial vs. the ALLOLD07 and ALLOPH07 trials. ECOG score and WBC count had prognostic significance for OS in ALLOPH07 and BURKIMAB08 trials, whereas no prognostic factors were identified in ALLOLD07 protocol. CONCLUSION: Subtype-oriented treatment had an impact in the outcome of older adults with ALL. The poorest outcome was observed in Ph-negative non-Mature B-cell ALL patients, for whom improvements in therapy are clearly needed.
BACKGROUND AND OBJECTIVE: The prognosis of acute lymphoblastic leukemia (ALL) is poor in older adults and elderly patients, and subtype-oriented prospective trials are scarce in these patients. We present the results of three prospective parallel subtype-oriented protocols in fit patients older than 55 years. PATIENTS AND METHODS: In 2008, three prospective phase II trials in patients older than 55 years were activated: ALLOLD07 for Philadephia (Ph) chromosome-negative ALL, ALLOPH07 for Ph-positive ALL, and BURKIMAB08 for mature B-ALL. Early death (ED), complete remission (CR), disease-free survival (DFS), overall survival (OS) and toxicity were analyzed. RESULTS: 56, 53 and 21 patients from the ALLOLD07, ALLOPH07 and BURKIMAB08 trials, respectively, were evaluable. CR was 74%, 87% and 70%, with an ED rate of 13%, 11% and 15%, respectively. The medians of DFS were 8 and 38 months for ALLOLD07 and ALLOPH07 protocols, not being achieved in the BURKIMAB08 trial (p=0.001), and the median OS was 12, 37 and 25 months, respectively (p=0.030). Neutropenia, thrombocytopenia and infections were less frequent in the ALLOPH07 trial vs. ALLOLD07 and BURKIMAB trials, and renal toxicity and mucositis were more frequent in the BURKIMAB08 trial vs. the ALLOLD07 and ALLOPH07 trials. ECOG score and WBC count had prognostic significance for OS in ALLOPH07 and BURKIMAB08 trials, whereas no prognostic factors were identified in ALLOLD07 protocol. CONCLUSION: Subtype-oriented treatment had an impact in the outcome of older adults with ALL. The poorest outcome was observed in Ph-negative non-Mature B-cell ALL patients, for whom improvements in therapy are clearly needed.
Authors: Mary-Elizabeth M Percival; Ryan C Lynch; Anna B Halpern; Mazyar Shadman; Ryan D Cassaday; Chaitra Ujjani; Andrei Shustov; Yolanda D Tseng; Catherine Liu; Steven Pergam; Edward N Libby; Bart L Scott; Stephen D Smith; Damian J Green; Ajay K Gopal; Andrew J Cowan Journal: JCO Oncol Pract Date: 2020-05-05