RELAPSE OF ACUTE LYMPHOBLASTIC LEUKAEMIA IN OLDER/ELDERLY PATIENTS - A SWEDISH POPULATION-BASED STUDY
(Abstract release date: 05/19/16)
EHA Library. Bergfelt Lennmyr E. 06/10/16; 133160; P172
Mrs. Emma Bergfelt Lennmyr
Contributions
Contributions
Abstract
Abstract: P172
Type: Poster Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 17:15 - 18:45
Location: Poster area (Hall H)
Background
Knowledge about relapsed acute lymphoblastic leukaemia (ALL) in older/elderly patients is scarce.
Aims
To study the outcome of ALL relapse treatment in a population-based cohort of older/elderly patients.
Methods
Out of the Swedish ALL-registry and cause of death-registry patients 55-85 years (y) old diagnosed with B- and T-ALL from 2005 to 2012 were identified. Clinical, laboratory and treatment data were validated and supplemented from medical records. Informed consent was obtained and the study approved by the local ethical committee in accordance with the declaration of Helsinki. Proportions were compared with chi-square test. Overall survival (OS) was estimated by the Kaplan Meier method and distribution compared with log-rank test using IBM SPSS package (v 23). Confidence intervals (CI) of 95% were obtained.
Results
Of 103 patients with B- and T-ALL receiving intensive treatment with achieved first complete remission (CR1), 63 (61%) relapsed (28 males and 35 females). Median age at relapse was 67y (57-83). B-ALL was present in 57/63, T-ALL in 6/63, and Philadelphia-positive (Ph+) disease in 19 of 61 patients (31%) (two with unknown Ph-status). Bone marrow was the sole relapse local in 57 (91%) patients. Median time from CR1 to relapse (TTR) was 9 moths (range: 1-93) and seven relapsed after allogeneic hematopoietic stem cell transplantation (hSCT). Treatment with the goal of a second complete remission (CR2) was applied in 33 patients and the first course consisted of the Swedish protocol ABCDV (n=8), FLAG-Asp (n=6), FLAG-Ida (n=3), MEA (n=4), FLAG (n=1), Hyper-CVAD (n=3), NOPHO adult protocol (n=1), nelarabine (n=1) or other combinations (n=6). Regimens were supplemented with tyrosine kinase inhibitor (TKI) in six patients, DLI in one and CAR-T in one patient.hSCT in CR2 was performed in three patients (of 10 considered for the procedure). Two of them died of relapse and transplant related mortality respectively and one is still alive after seven years.Palliation was given to the 30 remaining patients with CHOP/COP (n=5, with rituximab added in 2), other intravenous chemotherapy combinations (n=5), TKI [alone (n=5), with chemotherapy/cortisone (n=3), radiotherapy (n=1) and DLI (n=1)], cortisone and/or oral chemotherapy combinations (n=7), no treatment (n=1) and unknown (n=2).Remission induction was given predominantly in late (>1y) relapse [18/27 (67%) vs. 15/36 (42%); P=0.049]. In total, CR2 was achieved in 18 patients (29%) - 14/33 (42%) after remission induction and 4/30 (13%) after palliative treatment. Higher proportion of patients attained CR2 in late as compared with early relapse [13/27 (48%) vs. 5/36 (14%); P=0.003]. Median survival after relapse was 4 months (range: 0-95).The estimated 1 and 3y OS after relapse was 17 (CI: 7, 27)% and 7 (CI: 0, 14)%. There was no significant difference in OS between patients receiving remission induction and palliation. Age at relapse did not influence OS. Patients with late relapse had improved survival (P=0.001). CR2 achievement (as compared with treatment failure) enhanced survival in late [3y OS, CI: 34 (5, 64)% vs. 7 (0, 21)%; P=0.001] but not early relapse (no survivors at 3y; P=0.22).
Conclusion
Intensive treatment can be considered in older ALL patients in case of late relapse. However, for the majority of the patients, the prognosis was poor, which supports alternative approaches such as immunotherapy or novel drugs.
Session topic: Acute lymphoblastic leukemia - Clinical 1
Keyword(s): Adult, Elderly, Relapsed acute lymphoblastic leukemia
Type: Poster Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 17:15 - 18:45
Location: Poster area (Hall H)
Background
Knowledge about relapsed acute lymphoblastic leukaemia (ALL) in older/elderly patients is scarce.
Aims
To study the outcome of ALL relapse treatment in a population-based cohort of older/elderly patients.
Methods
Out of the Swedish ALL-registry and cause of death-registry patients 55-85 years (y) old diagnosed with B- and T-ALL from 2005 to 2012 were identified. Clinical, laboratory and treatment data were validated and supplemented from medical records. Informed consent was obtained and the study approved by the local ethical committee in accordance with the declaration of Helsinki. Proportions were compared with chi-square test. Overall survival (OS) was estimated by the Kaplan Meier method and distribution compared with log-rank test using IBM SPSS package (v 23). Confidence intervals (CI) of 95% were obtained.
Results
Of 103 patients with B- and T-ALL receiving intensive treatment with achieved first complete remission (CR1), 63 (61%) relapsed (28 males and 35 females). Median age at relapse was 67y (57-83). B-ALL was present in 57/63, T-ALL in 6/63, and Philadelphia-positive (Ph+) disease in 19 of 61 patients (31%) (two with unknown Ph-status). Bone marrow was the sole relapse local in 57 (91%) patients. Median time from CR1 to relapse (TTR) was 9 moths (range: 1-93) and seven relapsed after allogeneic hematopoietic stem cell transplantation (hSCT). Treatment with the goal of a second complete remission (CR2) was applied in 33 patients and the first course consisted of the Swedish protocol ABCDV (n=8), FLAG-Asp (n=6), FLAG-Ida (n=3), MEA (n=4), FLAG (n=1), Hyper-CVAD (n=3), NOPHO adult protocol (n=1), nelarabine (n=1) or other combinations (n=6). Regimens were supplemented with tyrosine kinase inhibitor (TKI) in six patients, DLI in one and CAR-T in one patient.hSCT in CR2 was performed in three patients (of 10 considered for the procedure). Two of them died of relapse and transplant related mortality respectively and one is still alive after seven years.Palliation was given to the 30 remaining patients with CHOP/COP (n=5, with rituximab added in 2), other intravenous chemotherapy combinations (n=5), TKI [alone (n=5), with chemotherapy/cortisone (n=3), radiotherapy (n=1) and DLI (n=1)], cortisone and/or oral chemotherapy combinations (n=7), no treatment (n=1) and unknown (n=2).Remission induction was given predominantly in late (>1y) relapse [18/27 (67%) vs. 15/36 (42%); P=0.049]. In total, CR2 was achieved in 18 patients (29%) - 14/33 (42%) after remission induction and 4/30 (13%) after palliative treatment. Higher proportion of patients attained CR2 in late as compared with early relapse [13/27 (48%) vs. 5/36 (14%); P=0.003]. Median survival after relapse was 4 months (range: 0-95).The estimated 1 and 3y OS after relapse was 17 (CI: 7, 27)% and 7 (CI: 0, 14)%. There was no significant difference in OS between patients receiving remission induction and palliation. Age at relapse did not influence OS. Patients with late relapse had improved survival (P=0.001). CR2 achievement (as compared with treatment failure) enhanced survival in late [3y OS, CI: 34 (5, 64)% vs. 7 (0, 21)%; P=0.001] but not early relapse (no survivors at 3y; P=0.22).
Conclusion
Intensive treatment can be considered in older ALL patients in case of late relapse. However, for the majority of the patients, the prognosis was poor, which supports alternative approaches such as immunotherapy or novel drugs.
Session topic: Acute lymphoblastic leukemia - Clinical 1
Keyword(s): Adult, Elderly, Relapsed acute lymphoblastic leukemia
Abstract: P172
Type: Poster Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 17:15 - 18:45
Location: Poster area (Hall H)
Background
Knowledge about relapsed acute lymphoblastic leukaemia (ALL) in older/elderly patients is scarce.
Aims
To study the outcome of ALL relapse treatment in a population-based cohort of older/elderly patients.
Methods
Out of the Swedish ALL-registry and cause of death-registry patients 55-85 years (y) old diagnosed with B- and T-ALL from 2005 to 2012 were identified. Clinical, laboratory and treatment data were validated and supplemented from medical records. Informed consent was obtained and the study approved by the local ethical committee in accordance with the declaration of Helsinki. Proportions were compared with chi-square test. Overall survival (OS) was estimated by the Kaplan Meier method and distribution compared with log-rank test using IBM SPSS package (v 23). Confidence intervals (CI) of 95% were obtained.
Results
Of 103 patients with B- and T-ALL receiving intensive treatment with achieved first complete remission (CR1), 63 (61%) relapsed (28 males and 35 females). Median age at relapse was 67y (57-83). B-ALL was present in 57/63, T-ALL in 6/63, and Philadelphia-positive (Ph+) disease in 19 of 61 patients (31%) (two with unknown Ph-status). Bone marrow was the sole relapse local in 57 (91%) patients. Median time from CR1 to relapse (TTR) was 9 moths (range: 1-93) and seven relapsed after allogeneic hematopoietic stem cell transplantation (hSCT). Treatment with the goal of a second complete remission (CR2) was applied in 33 patients and the first course consisted of the Swedish protocol ABCDV (n=8), FLAG-Asp (n=6), FLAG-Ida (n=3), MEA (n=4), FLAG (n=1), Hyper-CVAD (n=3), NOPHO adult protocol (n=1), nelarabine (n=1) or other combinations (n=6). Regimens were supplemented with tyrosine kinase inhibitor (TKI) in six patients, DLI in one and CAR-T in one patient.hSCT in CR2 was performed in three patients (of 10 considered for the procedure). Two of them died of relapse and transplant related mortality respectively and one is still alive after seven years.Palliation was given to the 30 remaining patients with CHOP/COP (n=5, with rituximab added in 2), other intravenous chemotherapy combinations (n=5), TKI [alone (n=5), with chemotherapy/cortisone (n=3), radiotherapy (n=1) and DLI (n=1)], cortisone and/or oral chemotherapy combinations (n=7), no treatment (n=1) and unknown (n=2).Remission induction was given predominantly in late (>1y) relapse [18/27 (67%) vs. 15/36 (42%); P=0.049]. In total, CR2 was achieved in 18 patients (29%) - 14/33 (42%) after remission induction and 4/30 (13%) after palliative treatment. Higher proportion of patients attained CR2 in late as compared with early relapse [13/27 (48%) vs. 5/36 (14%); P=0.003]. Median survival after relapse was 4 months (range: 0-95).The estimated 1 and 3y OS after relapse was 17 (CI: 7, 27)% and 7 (CI: 0, 14)%. There was no significant difference in OS between patients receiving remission induction and palliation. Age at relapse did not influence OS. Patients with late relapse had improved survival (P=0.001). CR2 achievement (as compared with treatment failure) enhanced survival in late [3y OS, CI: 34 (5, 64)% vs. 7 (0, 21)%; P=0.001] but not early relapse (no survivors at 3y; P=0.22).
Conclusion
Intensive treatment can be considered in older ALL patients in case of late relapse. However, for the majority of the patients, the prognosis was poor, which supports alternative approaches such as immunotherapy or novel drugs.
Session topic: Acute lymphoblastic leukemia - Clinical 1
Keyword(s): Adult, Elderly, Relapsed acute lymphoblastic leukemia
Type: Poster Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 17:15 - 18:45
Location: Poster area (Hall H)
Background
Knowledge about relapsed acute lymphoblastic leukaemia (ALL) in older/elderly patients is scarce.
Aims
To study the outcome of ALL relapse treatment in a population-based cohort of older/elderly patients.
Methods
Out of the Swedish ALL-registry and cause of death-registry patients 55-85 years (y) old diagnosed with B- and T-ALL from 2005 to 2012 were identified. Clinical, laboratory and treatment data were validated and supplemented from medical records. Informed consent was obtained and the study approved by the local ethical committee in accordance with the declaration of Helsinki. Proportions were compared with chi-square test. Overall survival (OS) was estimated by the Kaplan Meier method and distribution compared with log-rank test using IBM SPSS package (v 23). Confidence intervals (CI) of 95% were obtained.
Results
Of 103 patients with B- and T-ALL receiving intensive treatment with achieved first complete remission (CR1), 63 (61%) relapsed (28 males and 35 females). Median age at relapse was 67y (57-83). B-ALL was present in 57/63, T-ALL in 6/63, and Philadelphia-positive (Ph+) disease in 19 of 61 patients (31%) (two with unknown Ph-status). Bone marrow was the sole relapse local in 57 (91%) patients. Median time from CR1 to relapse (TTR) was 9 moths (range: 1-93) and seven relapsed after allogeneic hematopoietic stem cell transplantation (hSCT). Treatment with the goal of a second complete remission (CR2) was applied in 33 patients and the first course consisted of the Swedish protocol ABCDV (n=8), FLAG-Asp (n=6), FLAG-Ida (n=3), MEA (n=4), FLAG (n=1), Hyper-CVAD (n=3), NOPHO adult protocol (n=1), nelarabine (n=1) or other combinations (n=6). Regimens were supplemented with tyrosine kinase inhibitor (TKI) in six patients, DLI in one and CAR-T in one patient.hSCT in CR2 was performed in three patients (of 10 considered for the procedure). Two of them died of relapse and transplant related mortality respectively and one is still alive after seven years.Palliation was given to the 30 remaining patients with CHOP/COP (n=5, with rituximab added in 2), other intravenous chemotherapy combinations (n=5), TKI [alone (n=5), with chemotherapy/cortisone (n=3), radiotherapy (n=1) and DLI (n=1)], cortisone and/or oral chemotherapy combinations (n=7), no treatment (n=1) and unknown (n=2).Remission induction was given predominantly in late (>1y) relapse [18/27 (67%) vs. 15/36 (42%); P=0.049]. In total, CR2 was achieved in 18 patients (29%) - 14/33 (42%) after remission induction and 4/30 (13%) after palliative treatment. Higher proportion of patients attained CR2 in late as compared with early relapse [13/27 (48%) vs. 5/36 (14%); P=0.003]. Median survival after relapse was 4 months (range: 0-95).The estimated 1 and 3y OS after relapse was 17 (CI: 7, 27)% and 7 (CI: 0, 14)%. There was no significant difference in OS between patients receiving remission induction and palliation. Age at relapse did not influence OS. Patients with late relapse had improved survival (P=0.001). CR2 achievement (as compared with treatment failure) enhanced survival in late [3y OS, CI: 34 (5, 64)% vs. 7 (0, 21)%; P=0.001] but not early relapse (no survivors at 3y; P=0.22).
Conclusion
Intensive treatment can be considered in older ALL patients in case of late relapse. However, for the majority of the patients, the prognosis was poor, which supports alternative approaches such as immunotherapy or novel drugs.
Session topic: Acute lymphoblastic leukemia - Clinical 1
Keyword(s): Adult, Elderly, Relapsed acute lymphoblastic leukemia
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