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Receipt of maintenance therapy is most predictive of survival in older acute lymphoblastic leukemia patients treated with intensive induction chemotherapy regimens
Author(s) -
Landsburg Daniel J.,
Stadtmauer Edward,
Loren Alison,
Goldstein Steven,
Frey Noelle,
Nasta Sunita D.,
Porter David L.,
Tsai Donald E.,
Perl Alexander E.,
Hexner Elizabeth O.,
Luger Selina
Publication year - 2013
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23468
Subject(s) - medicine , maintenance therapy , chemotherapy , regimen , univariate analysis , population , acute lymphocytic leukemia , chemotherapy regimen , leukemia , pediatrics , multivariate analysis , lymphoblastic leukemia , environmental health
While the prognosis for older adults diagnosed with acute lymphoblastic leukemia (ALL) is frequently poor, long‐term survival can be achieved in patients treated with curative intent. We reviewed the outcomes of 37 patients age ≥60 treated at our institution with either DVP‐ or hyperCVAD‐based chemotherapy regimens from 2003–2011. In this patient population, a complete response rate of 92%, relapse rate of 56% and median overall survival of 18.1 months was experienced. Univariate analysis revealed that receipt of maintenance therapy vs. no maintenance therapy was associated with a statistically‐significant impact on overall survival ( p = 0.001, HR 0.15 for death), while disease‐related characteristics including high‐risk white blood cell count at diagnosis and Philadelphia chromosome status as well as treatment‐related factors including chemotherapy regimen or completion of intensive therapy were not. Many patients were unable to initiate or remain on maintenance therapy due to toxicities including infections and cytopenias. Our analysis reveals the benefit of prolonged therapy in the treatment of older adults with ALL as well as the high incidence of treatment‐related toxicity experienced by these patients. Am. J. Hematol. 88:657–660, 2013. © 2013 Wiley Periodicals, Inc.