Josep-Maria Ribera1, Olga García2, Cristina Gil3, Santiago Mercadal4, Irene García-Cadenas5, Pau Montesinos6, Pere Barba7, Susana Vives2, José González-Campos8, Mar Tormo9, Jordi Esteve10, Aurelio López11, María José Moreno12, Jordi Ribera2, Natalia Alonso13, Arancha Bermúdez14, María Luz Amigo15, Eulàlia Genescà2, Daniel García16, Ferran Vall-Llovera17, Juan Miguel Bergua18, Ramon Guàrdia19, María Carmen Monteserín20, Teresa Bernal21, María Calbacho22, María Pilar Martínez23, Evarist Feliu2. 1. ICO Badalona-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Badalona, Spain. Electronic address: jribera@iconcologia.net. 2. ICO Badalona-Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute (IJC), Universitat Autònoma de Barcelona, Badalona, Spain. 3. Hospital General Universitario de Alicante, Alicante, Spain. 4. Institut Català d'Oncologia-Hospital Duran i Reynals, L'Hospitalet de Llobregat, Spain. 5. Hospital de Sant Pau, Barcelona, Spain. 6. Hospital Universitario y Politécnico La Fe, Valencia, Spain. 7. Hospital Vall d'Hebron, Barcelona, Spain. 8. Hospital Universitario Virgen del Rocío, Sevilla, Spain. 9. Hospital Clínico, Valencia, Spain. 10. Hospital Clínic, Barcelona, Spain. 11. Hospital Arnau deVilanova, Valencia, Spain. 12. Hospital Clínico, Málaga, Spain. 13. Complejo Hospitalario Universitario, Santiago de Compostela, Spain. 14. Hospital Marqués de Valdecilla, Santander, Spain. 15. Hospital General Universitario Morales Meseguer, Murcia, Spain. 16. Hospital La Zarzuela, Madrid, Spain. 17. Hospital Mútua de Terrassa, Terrassa, Spain. 18. Hospital San Pedro de Alcántara, Cáceres, Spain. 19. Institut Català d'Oncologia-Hospital Doctor Trueta. Girona, Spain. 20. Hospital Universitario de Getafe, Getafe, Spain. 21. Hospital Central de Asturias, Oviedo, Spain. 22. Hospital Ramón y Cajal, Madrid, Spain. 23. Hospital Doce de Octubre, Madrid, Spain.
Abstract
BACKGROUND AND OBJECTIVE: The standardization of treatment of older adults with Philadelphia chromosome negative (Ph-) acute lymphoblastic leukemia (ALL) is challenging, especially in the age range of 55-65 years. This study aimed to compare intensive, pediatric-inspired therapy with non-intensive therapy in this population of patients. PATIENTS AND METHODS: The outcomes of 67 patients prospectively included in two consecutive pediatric-inspired intensive protocols (ALL-HR03 and ALL-HR11) from the Spanish PETHEMA Group were compared with those from 44 patients included in a contemporary semi-intensive protocol (ALL-OLD07). RESULTS: Baseline patient and ALL characteristics were similar in both groups, except for a younger median age in the intensive group (medians: 58 vs. 62 years). Patients treated intensively had a higher complete remission rate (85% vs. 64%, p = 0.005), a lower cumulative incidence of relapse (39% [95%CI, 25% to 52%] vs. 60% [95%CI, 38% to 77%], p = .003), a similar cumulative incidence of treatment-related mortality (28% [95% CI, 18%, 40%] vs. 21% [95% CI, 10%, 34%]) and superior event-free survival at 2 years (37% [95%CI, 25%-49%) vs. 21% [8%-34%], p = 0.002). On multivariable analysis the type of protocol was the only variable with independent significance for event-free survival (HR [95% CI]: 2 [1.3, 3], p = .002). CONCLUSIONS: Compared with less intensive chemotherapy, pediatric-inspired intensive chemotherapy significantly improves the outcome of older adults with Ph-negative ALL in the age range of 55-65 years.
BACKGROUND AND OBJECTIVE: The standardization of treatment of older adults with Philadelphia chromosome negative (Ph-) acute lymphoblastic leukemia (ALL) is challenging, especially in the age range of 55-65 years. This study aimed to compare intensive, pediatric-inspired therapy with non-intensive therapy in this population of patients. PATIENTS AND METHODS: The outcomes of 67 patients prospectively included in two consecutive pediatric-inspired intensive protocols (ALL-HR03 and ALL-HR11) from the Spanish PETHEMA Group were compared with those from 44 patients included in a contemporary semi-intensive protocol (ALL-OLD07). RESULTS: Baseline patient and ALL characteristics were similar in both groups, except for a younger median age in the intensive group (medians: 58 vs. 62 years). Patients treated intensively had a higher complete remission rate (85% vs. 64%, p = 0.005), a lower cumulative incidence of relapse (39% [95%CI, 25% to 52%] vs. 60% [95%CI, 38% to 77%], p = .003), a similar cumulative incidence of treatment-related mortality (28% [95% CI, 18%, 40%] vs. 21% [95% CI, 10%, 34%]) and superior event-free survival at 2 years (37% [95%CI, 25%-49%) vs. 21% [8%-34%], p = 0.002). On multivariable analysis the type of protocol was the only variable with independent significance for event-free survival (HR [95% CI]: 2 [1.3, 3], p = .002). CONCLUSIONS: Compared with less intensive chemotherapy, pediatric-inspired intensive chemotherapy significantly improves the outcome of older adults with Ph-negative ALL in the age range of 55-65 years.
Authors: Emma Lennmyr; Karin Karlsson; Lucia Ahlberg; Hege Garelius; Erik Hulegårdh; Antonio S Izarra; Joel Joelsson; Piotr Kozlowski; Andreea Moicean; Beata Tomaszewska-Toporska; Anna Lübking; Helene Hallböök Journal: Eur J Haematol Date: 2019-06-06 Impact factor: 2.997