Contributions
Abstract: EP349
Type: E-Poster Presentation
Session title: Acute lymphoblastic leukemia - Clinical
Background
The clinical features, treatments, and survivals of adult ALL patients are very different from the paediatric ALL patients. In the past decades, tyrosine kinase inhibitors (TKI) demonstrate clinical benefits in Philadelphia chromosome-positive ALL patients. Nevertheless, data on the epidemiology, treatment patterns, and survivals of adult ALL patients in the era of TKI are very limited, particularly in the Asia Pacific region.
Aims
The aim of this study was to investigate the incidence, treatment patterns, and survivals of adult ALL patients in Taiwan.
Methods
We conducted a population-based retrospective cohort study and used data from the Taiwan Cancer Registry Database (TCRD), the National Health Insurance Research Database, and the National Death Registry. From the TCRD, we identified patients older than 18 years with newly diagnosed ALL from January 2002 to December 2017. The crude and adjusted annual incident rates of adult ALL were reported. Among all identified adult ALL patients, we further included the patients with newly diagnosed B-ALL from 2009 to 2015 for further analysis of treatment patterns and survivals. We stratified the newly diagnosed B-ALL patients by the use of TKI (TKI-containing treatments or TKI-free treatments). The clinical features, treatment patterns, and clinical outcomes including complete remission rate, refractory rate, and survival of the two groups were reported.
Results
We identified 1800 adult ALL patients between 2002 and 2016. The incidence of adult ALL was 0.69 cases per 100,000 person-years with male predominance. The median age at diagnosis was 44 years old. The incidence rates of adult ALL was highest in the age group of 19-25 and 60+ with 0.8 and 0.88 cases per 100,000 person-years, respectively.
Among 765 adult patients with newly diagnosed B-cell ALL during 2009 and 2015, 429(56.1%) patients received TKI-free treatments, 223(29.2%) patients received TKI-containing treatments, and others did not receive standard chemotherapies. The median age of patients receiving TKI-free treatments and TKI-containing treatments was 46 and 48 years old, respectively. Age is an important prognostic factor in adult B-ALL patients. The median overall survival (mOS) was 37.51, 32.36, 17.59, and 3.56 months in the age groups of 19-25 years, 26-39 years, 40-59 years and 60+ years respectively.
In the TKI-free treatment group, the median time to induction treatment was 7 days. 217 (50.6%) patients achieved complete remission, 40(9.3%) encountered refractory disease, and 172 (40.1%) died within 9 months after the initiation of induction chemotherapy. The median followed up duration was 30.2 months with a cumulative mortality of 74.8%, and 128(29.8%) patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). The mOS was 13.67(95% CI: 11.87-16.33) months in the TKI-free treatment group.
In the TKI-containing treatment group, the median time to induction treatment was 16 days. 210(94.2%) patients received imatinib and 13(5.8%) patients received dasatinib as the first line TKI. The median followed up duration was 36.2 months with a cumulative mortality of 64.6%. 90(40.4%) patients underwent allo-HSCT. The mOS was 26.89 (95% CI: 19.51-33.97) months in the TKI treatment group.
Conclusion
This study is the first population-based study conducted in Asia providing comprehensive evidence of epidemiology, treatment patterns and survival of adult ALL. Compared with patients receiving TKI-free treatments, patients receiving TKI-containing treatments had better survival and higher proportion of them underwent allo-HSCT.
Keyword(s): Acute lymphoblastic leukemia, Epidemiology
Abstract: EP349
Type: E-Poster Presentation
Session title: Acute lymphoblastic leukemia - Clinical
Background
The clinical features, treatments, and survivals of adult ALL patients are very different from the paediatric ALL patients. In the past decades, tyrosine kinase inhibitors (TKI) demonstrate clinical benefits in Philadelphia chromosome-positive ALL patients. Nevertheless, data on the epidemiology, treatment patterns, and survivals of adult ALL patients in the era of TKI are very limited, particularly in the Asia Pacific region.
Aims
The aim of this study was to investigate the incidence, treatment patterns, and survivals of adult ALL patients in Taiwan.
Methods
We conducted a population-based retrospective cohort study and used data from the Taiwan Cancer Registry Database (TCRD), the National Health Insurance Research Database, and the National Death Registry. From the TCRD, we identified patients older than 18 years with newly diagnosed ALL from January 2002 to December 2017. The crude and adjusted annual incident rates of adult ALL were reported. Among all identified adult ALL patients, we further included the patients with newly diagnosed B-ALL from 2009 to 2015 for further analysis of treatment patterns and survivals. We stratified the newly diagnosed B-ALL patients by the use of TKI (TKI-containing treatments or TKI-free treatments). The clinical features, treatment patterns, and clinical outcomes including complete remission rate, refractory rate, and survival of the two groups were reported.
Results
We identified 1800 adult ALL patients between 2002 and 2016. The incidence of adult ALL was 0.69 cases per 100,000 person-years with male predominance. The median age at diagnosis was 44 years old. The incidence rates of adult ALL was highest in the age group of 19-25 and 60+ with 0.8 and 0.88 cases per 100,000 person-years, respectively.
Among 765 adult patients with newly diagnosed B-cell ALL during 2009 and 2015, 429(56.1%) patients received TKI-free treatments, 223(29.2%) patients received TKI-containing treatments, and others did not receive standard chemotherapies. The median age of patients receiving TKI-free treatments and TKI-containing treatments was 46 and 48 years old, respectively. Age is an important prognostic factor in adult B-ALL patients. The median overall survival (mOS) was 37.51, 32.36, 17.59, and 3.56 months in the age groups of 19-25 years, 26-39 years, 40-59 years and 60+ years respectively.
In the TKI-free treatment group, the median time to induction treatment was 7 days. 217 (50.6%) patients achieved complete remission, 40(9.3%) encountered refractory disease, and 172 (40.1%) died within 9 months after the initiation of induction chemotherapy. The median followed up duration was 30.2 months with a cumulative mortality of 74.8%, and 128(29.8%) patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). The mOS was 13.67(95% CI: 11.87-16.33) months in the TKI-free treatment group.
In the TKI-containing treatment group, the median time to induction treatment was 16 days. 210(94.2%) patients received imatinib and 13(5.8%) patients received dasatinib as the first line TKI. The median followed up duration was 36.2 months with a cumulative mortality of 64.6%. 90(40.4%) patients underwent allo-HSCT. The mOS was 26.89 (95% CI: 19.51-33.97) months in the TKI treatment group.
Conclusion
This study is the first population-based study conducted in Asia providing comprehensive evidence of epidemiology, treatment patterns and survival of adult ALL. Compared with patients receiving TKI-free treatments, patients receiving TKI-containing treatments had better survival and higher proportion of them underwent allo-HSCT.
Keyword(s): Acute lymphoblastic leukemia, Epidemiology