Feasibility and results of subtype-oriented protocols in older adults and fit elderly patients with acute lymphoblastic leukemia: Results of three prospective parallel trials from the PETHEMA group

Josep Maria Ribera, Olga García, Albert Oriol, Cristina Gil, Pau Montesinos, Teresa Bernal, José González-Campos, Esperanza Lavilla, Jordi Ribera, Salut Brunet, María Pilar Martínez, Mar Tormo, Eulàlia Genescà, Pere Barba, Josep Sarrà, María Carmen Monteserín, Beatriz Soria, Mercedes Colorado, Antònia Cladera, Antoni García-GuiñónMaría Calbacho, Alfons Serrano, Xavier Ortín, María Pedreño, Maria Luz Amigo, Lourdes Escoda, Evarist Feliu

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28 Citations (Scopus)

Abstract

Copyright © 2015 Elsevier Ltd. All rights reserved. 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.
Original languageEnglish
Pages (from-to)12-20
JournalLeukemia Research
Volume41
DOIs
Publication statusPublished - 1 Feb 2016

Keywords

  • Acute lymphoblastic leukemia
  • Elderly
  • Risk-adapted therapy

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