Comparison of intensive, pediatric-inspired therapy with non-intensive therapy in older adults aged 55–65 years with Philadelphia chromosome-negative acute lymphoblastic leukemia

Josep Maria Ribera, Olga García, Cristina Gil, Santiago Mercadal, Irene García-Cadenas, Pau Montesinos, Pere Barba, Susana Vives, José González-Campos, Mar Tormo, Jordi Esteve, Aurelio López, María José Moreno, Jordi Ribera, Natalia Alonso, Arancha Bermúdez, María Luz Amigo, Eulàlia Genescà, Daniel García, Ferran Vall-LloveraJuan Miguel Bergua, Ramon Guàrdia, María Carmen Monteserín, Teresa Bernal, María Calbacho, María Pilar Martínez, Evarist Feliu

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Abstract

© 2018 Elsevier Ltd 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.
Original languageEnglish
Pages (from-to)79-84
JournalLeukemia Research
Volume68
DOIs
Publication statusPublished - 1 May 2018

Keywords

  • Acute lymphoblastic leukemia
  • Chemotherapy
  • Older adults
  • Philadelphia chromosome-negative

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    Ribera, J. M., García, O., Gil, C., Mercadal, S., García-Cadenas, I., Montesinos, P., Barba, P., Vives, S., González-Campos, J., Tormo, M., Esteve, J., López, A., Moreno, M. J., Ribera, J., Alonso, N., Bermúdez, A., Amigo, M. L., Genescà, E., García, D., ... Feliu, E. (2018). Comparison of intensive, pediatric-inspired therapy with non-intensive therapy in older adults aged 55–65 years with Philadelphia chromosome-negative acute lymphoblastic leukemia. Leukemia Research, 68, 79-84. https://doi.org/10.1016/j.leukres.2018.03.010