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

• Published in: Annals of hematology Vol. 101; no. 5; pp. 1097 - 1106
• Main Authors: Hofer, Kevin D., Schanz, Urs, Schwotzer, Rahel, Nair, Gayathri, Manz, Markus G., Widmer, Corinne C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2022; Springer Nature B.V
• Subjects: Adult; Aged; Child; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Medical prognosis; Medicine; Medicine & Public Health; Oncology; Original; Original Article; Pediatrics; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prognosis; Remission Induction; Retrospective Studies; Stem cell transplantation; Treatment; Allogeneic hematopoietic stem cell transplantation; Acute lymphoblastic leukemia; Elderly
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s00277-022-04793-z

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.