The Challenges of Managing Older Patients with Acute Lymphoblastic Leukemia

2015 ◽  
pp. e343-e351 ◽  
Author(s):  
David I. Marks
Keyword(s):  
United Kingdom ◽  
Acute Lymphoblastic Leukemia ◽  
Older Patients ◽  
Lymphoblastic Leukemia ◽  
Therapeutic Modality ◽  
Published Data ◽  
Curative Intent ◽  
Cell Therapies ◽  
The United Kingdom ◽  
Therapeutic Decisions

Acute lymphoblastic leukemia (ALL), predominantly a disease of children, has a second incidence peak in older adults. Patients older than age 50 but younger than age 65 may be included in trials of intensive treatment with curative intent, but their outcome is poor with high nonrelapse mortality (NRM), high relapse rates, and low overall survival. Using limited published data from the United Kingdom ALL XII and HOVON trials, this manuscript explores the reasons for the high transplant-related mortality (TRM) and presents early data from the United Kingdom ALL 60+ and United Kingdom ALL XIV studies. Factors affecting therapeutic decisions for older patients are discussed. A case study illustrates some of the issues involved in managing these patients and the need to individualize therapy and consider all options. There may be a role for reduced intensity allografting in selected, fitter patients older than age 50; this article presents preliminary transplant data from United Kingdom ALL XIV that prospectively assesses this therapeutic modality. Detailed discussion of tyrosine kinase inhibitors and the potential place of novel targeted antibodies and immune T-cell therapies will be not discussed in detail. Finally, there is a description of the major outstanding issues and the trials that are needed to inform decision making and improve outcome in this challenging group of patients.

scholarly journals A population-based cytogenetic study of adults with acute lymphoblastic leukemia

Blood ◽  
2010 ◽  
Vol 115 (2) ◽  
pp. 206-214 ◽  
Author(s):  
Anthony V. Moorman ◽  
Lucy Chilton ◽  
Jennifer Wilkinson ◽  
Hannah M. Ensor ◽  
Nick Bown ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Acute Lymphoblastic Leukemia ◽  
Older Patients ◽  
Chromosomal Abnormalities ◽  
Cytogenetic Study ◽  
Lymphoblastic Leukemia ◽  
Population Based ◽  
Published Data ◽  
Complex Karyotype ◽  
Adult Acute Lymphoblastic Leukemia

AbstractChromosomal abnormalities are increasingly used to risk stratify adults with acute lymphoblastic leukemia. Published data describing the age-specific incidence of chromosomal abnormalities and their prognostic relevance are largely derived from clinical trials. Trials frequently have age restrictions and low recruitment rates. Thus we investigated these factors in a population-based cohort of 349 patients diagnosed during the course of 19 years in the northern part of England. The incidence of most chromosomal abnormalities varied significantly with age. The incidence of t(9;22)(q34;q11) increased in each successive decade, up to 24% among 40- to 49-year-old subjects. Thereafter the incidence reached a plateau. t(4;11)(q21;q23) and t(1;19)(q23;p13) were a rare occurrence among patients older than 60 years of age. In contrast, the frequency of t(8;14)(q24;q32) and t(14;18)(q32;q21) increased with age. High hyperdiploidy occurred in 13% of patients younger than 20 years of age but in only 5% of older patients. The incidence of low hypodiploidy/near-triploidy and complex karyotype increased with age from 4% (15-29 years) to 16% (≥ 60 years). Overall survival varied significantly by age and cytogenetics. Older patients and those with t(9;22), t(4;11), low hypodiploidy/near-triploidy, or complex karyotype had a significantly inferior outcome. These population-based results demonstrate the cytogenetic heterogeneity of adult acute lymphoblastic leukemia. These data will inform the delivery of routine clinical services and the design of new age-focused clinical trials.

scholarly journals Dose-Adjusted Intensive Chemotherapy Is Safe and Tolerable in Older Patients with Ph-Negative ACUTE Lymphoblastic Leukemia

2019 ◽  
Vol 25 (3) ◽  
pp. S429-S430
Author(s):  
Anne S. Renteria ◽  
Sangeetha Venugopal ◽  
Bridget Marcellino ◽  
Michal Bar-Natan ◽  
Marina Kremyanskaya ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Older Patients ◽  
Lymphoblastic Leukemia ◽  
Intensive Chemotherapy

scholarly journals Approach to the Adult Acute Lymphoblastic Leukemia Patient

2019 ◽  
Vol 8 (8) ◽  
pp. 1175 ◽  
Author(s):  
Valentina Sas ◽  
Vlad Moisoiu ◽  
Patric Teodorescu ◽  
Sebastian Tranca ◽  
Laura Pop ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Molecular Mechanisms ◽  
High Throughput Sequencing ◽  
Kinase Inhibitors ◽  
Lymphoblastic Leukemia ◽  
Survival Rates ◽  
High Risk Patient ◽  
Late Relapse ◽  
Published Data ◽  
Hematopoietic Stem

During recent decades, understanding of the molecular mechanisms of acute lymphoblastic leukemia (ALL) has improved considerably, resulting in better risk stratification of patients and increased survival rates. Age, white blood cell count (WBC), and specific genetic abnormalities are the most important factors that define risk groups for ALL. State-of-the-art diagnosis of ALL requires cytological and cytogenetical analyses, as well as flow cytometry and high-throughput sequencing assays. An important aspect in the diagnostic characterization of patients with ALL is the identification of the Philadelphia (Ph) chromosome, which warrants the addition of tyrosine kinase inhibitors (TKI) to the chemotherapy backbone. Data that support the benefit of hematopoietic stem cell transplantation (HSCT) in high risk patient subsets or in late relapse patients are still questioned and have yet to be determined conclusive. This article presents the newly published data in ALL workup and treatment, putting it into perspective for the attending physician in hematology and oncology.

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