ACUTE LYMPHOBLASTIC LEUKEMIA OF THE ELDERLY: CLINICAL FEATURES, PROGNOSIS AND
POSTER 32
TREATMENT OUTCOME
Maria Papathanasiou, Eirini Balntoumi, Anastasia Marvaki, Michail Iskas, Christos Demosthenous,
Anastasia Athanasiadou, Aygi Lalayanni and Achilles Anagnostopoulos
Hematology Department & HCT Unit, G. Papanikolaou Hospital, Thessaloniki, Greece
Acute Lymphoblastic Leukemia (ALL) is rare in older patients, characterized by special features and
divergent biological behavior. Contrary to the progress achieved in the survival of younger patients,
low rates of complete remissions (CR) and disease free survival (DFS) in this age group makes their
management challenging. Poor performance status and patient or disease-related comorbidities limit
the administration of intensive treatment regimens and stem cell transplantation (SCT).
We studied retrospectively 33 elderly out of 193 patients with ALL (9 male, 24 female) with median
age 66 (55-85) years. Thirty patients had B-ALL (12 pre-ALL, 5 pro-ALL, 8 common-ALL) and 3 had T-ALL.
Eighteen patients had poor cytogenetic characteristics: 13 patients were Philadelphia (Ph)
chromosome positive (+), 2 had hypotriploid karyotype and 3 had 11q23 abnormalities. Twelve
patients co-expressed myeloid markers, two of which were diagnosed with MPAL leukemia. Sixteen
patients demonstrated a high leukocyte count (>30.000), 10 had grade IV thrombocytopenia and 10
presented with severe anemia (Hb<8.5gr/dl). Seven patients had organomegaly and 2 presented with
CNS involvement.
Twenty one patients received complete treatment protocol (induction, consolidation, maintenance)
and 11 needed dose reduction. Ph (+) patients additionally received a TK inhibitor (imatinib,
dasatinib). Two patients received novel TK inhibitors (1 bosutinib, 1 ponatinib) on relapse. All
patients received intrathecal chemotherapy prophylaxis.
Complete remission was achieved in 23 patients (70%), but 13 eventually relapsed (56%). Treatment
related deaths occurred in 6 (13%), the majority over 60 years old. Two patients developed
secondary malignancies (pancreatic-colon cancer). Ten patients (30%) survived and remain in CR. No
patients underwent SCT because of age, comorbidities and disease relapse.
Multifactorial analysis of patient characteristics showed statistically significant differences in high
leucocyte count (p=0.015), low platelet count (p=0.045) and presence of Ph chromosome (39% vs
13%) compared to younger patients with ALL. The estimated 5 year overall survival (OS) was 29%
(median: 20 months) and DFS was 22%. The different rates in OS (65% vs 29%, p<0.001) and DFS
(51% vs 22%, p<0.001) in comparison to the young confirms the poor outcome in this age group. Age
over 50 and increased LDH value were statistically significant factors related to survival.
Prognosis of ALL in the elderly remains poor. Intensive treatment regimens, with or without SCT,
though successfully administered in younger patients, are not well tolerated by the elderly. There is
unmet need for more effective and less toxic therapeutic regimens such as targeted and
immunotherapeutic agents.
SCIENTIFIC
PROGRAMME
RARE SUBSETS OF
ACUTE LEUKAEMIA
TRACKING LEUKAEMIC
STEM CELLS (LSCs)
ROUTINE DIAGNOSIS
GENE EXPRESSION
AND MUTATIONAL
PROFILING
DEBATE 1 – ALL
PATIENTS WITH
INTERMEDIATE-RISK
AML MUST BE
TRANSPLANTED
INTERACTIVE
CASES 1 – MUTATION-BASED
THERAPY
OFF-LABEL
ROUNDTABLE –
SHOULD WE REALLY
USE NEW TARGETED
INHIBITORS AS SINGLE
AGENTS ?
ADDITION OF A 3RD
AGENT TO FRONTLINE
7+3
ROUNDTABLE –
CURATIVE OPTIONS
FOR OLDER AML
INTERACTIVE CASES 2
DEBATE 2 - BEST
TREATMENT FOR
NPM1-MUTATED AML IN
THE NEXT FUTURE ?
ALLOGENEIC
HAEMATOPOIETIC
STEM CELL
TRANSPLANTATION
(HSCT)
IMMUNOTHERAPY FOR
ACUTE LEUKAEMIA
DEBATE 3 - T-ALL:
WHERE ARE WE GOING
NOW?
SELECTED ABSTRACTS
AND CLINICAL
CASES FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FOR A POSTER
PRESENTATION
DISCLOSURES