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. 2022 May;101(5):1097-1106.
doi: 10.1007/s00277-022-04793-z. Epub 2022 Feb 19.

Real-world outcomes in elderly ALL patients with and without allogeneic hematopoietic stem cell transplantation: a single-center evaluation over 10 years

Kevin D Hofer  1 , Urs Schanz  2 , Rahel Schwotzer  2 , Gayathri Nair  2 , Markus G Manz  2 , Corinne C Widmer  3
Affiliations

Real-world outcomes in elderly ALL patients with and without allogeneic hematopoietic stem cell transplantation: a single-center evaluation over 10 years

Kevin D Hofer et al. Ann Hematol. 2022 May.

Abstract

Elderly patients (EP) of 60 years and above with acute lymphoblastic leukemia (ALL) have a dismal prognosis, but pediatric-inspired chemotherapy and allogeneic stem cell transplantation (allo HCT) are used reluctantly due to limited data and historical reports of high treatment-related mortality in EP. We analyzed 130 adult ALL patients treated at our center between 2009 and 2019, of which 26 were EP (range 60-76 years). Induction with pediatric-inspired protocols was feasible in 65.2% of EP and resulted in complete remission in 86.7% compared to 88.0% in younger patients (YP) of less than 60 years. Early death occurred in 6.7% of EP. Three-year overall survival (OS) for Ph - B-ALL was significantly worse for EP (n = 16) than YP (n = 64) with 30.0% vs 78.1% (p ≤ 0.001). Forty-nine patients received allo HCT including 8 EP, for which improved 3-year OS of 87.5% was observed, whereas EP without allo HCT died after a median of 9.5 months. In Ph + B-ALL, 3-year OS did not differ between EP (60.0%, n = 7) and YP (70.8%, n = 19). Non-relapse mortality and infection rate were low in EP (14.3% and 12.5%, respectively). Our data indicate that selected EP can be treated effectively and safely with pediatric regimens and might benefit from intensified therapy including allo HCT.

Keywords: Acute lymphoblastic leukemia; Allogeneic hematopoietic stem cell transplantation; Elderly; Treatment.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
a Enrollment of patients. b Overview of induction therapy and allogeneic stem cell transplantation based on type of ALL. CR complete response, r/r relapsed or refractory ALL
Fig. 2
Fig. 2
Complications after allogeneic stem cell transplantation. GVHD graft-versus-host-disease
Fig. 3
Fig. 3
Overall survival and leukemia-free survival in elderly and young patients with ALL based on status of Philadelphia chromosome and performance of allo HCT. Shown are Kaplan–Meier plots for overall survival in elderly and young patients with ALL (a), overall survival for subgroups of Philadelphia chromosome-positive and negative ALL (b), overall survival in patients undergoing allogeneic stem cell transplantation (c), and leukemia-free survival of transplanted patients (d). Plots are calculated as the time to death or lost to follow-up, and p values calculated by the log-rank test. Tick marks indicate censored data
Fig. 4
Fig. 4
Cumulative incidence of relapse and non-relapse mortality. NRM non-relapse mortality
See this image and copyright information in PMC

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