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Treatment of elderly patients with acute lymphoblastic leukaemia using a paediatric‐based protocol
Author(s) -
Poch Martell Marc,
Atenafu Eshetu G.,
Minden Mark D.,
Schuh Andre C.,
Yee Karen W. L.,
Schimmer Aaron D.,
Gupta Vikas,
Brandwein Joseph M.
Publication year - 2013
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12561
Subject(s) - medicine , regimen , induction chemotherapy , chemotherapy , acute lymphocytic leukemia , maintenance therapy , surgery , pediatrics , lymphoblastic leukemia , leukemia
Summary All newly diagnosed patients aged 60–79 years with acute lymphoblastic leukaemia ( ALL ) receiving induction chemotherapy with a modified paediatric‐based regimen over a 7‐year period were retrospectively analysed ( n = 51, median age 65 years). The treatment regimen consisted of induction, central nervous system prophylaxis, seven cycles of intensification and 24 cycles of maintenance. BCR ‐ ABL 1 negative patients received weekly asparaginase during intensification, while BCR ‐ ABL 1 + patients received daily imatinib. Post‐remission therapy was given in an outpatient setting. The complete response rate was 75%, with an induction mortality of 20%; 6% of patients had resistant disease. 37% of patients who achieved a complete remission relapsed. The estimated 5‐year overall survival was 40% for BCR ‐ ABL 1 negative and 47% for BCR ‐ ABL 1 + patients ( P = not significant); the 5‐year disease‐free survival was 57% and 39%, respectively ( P = NS ). The post‐induction phase was generally well tolerated, with 81% able to complete the intensification phase and proceed to maintenance. In conclusion, administration of this modified paediatric‐based protocol is feasible and active for elderly patients with ALL . Survival is superior to most previously reported series in this age group, but remains worse compared to younger patients. Further improvement of the toxicity profile, particularly during induction, is required to improve outcomes.