Treatment of Frail Older Adults and Elderly Patients With Philadelphia Chromosome-negative Acute Lymphoblastic Leukemia: Results of a Prospective Trial With Minimal Chemotherapy
Por:
Ribera, JM, Garcia, O, Chapchap, EC, Gil, C, Gonzalez-Campos, J, Barba, P, Amigo, ML, Moreno, MJ, Lavilla, E, Alonso, N, Bergua, JM, Tormo, M, Ribera, J, Sierra, M, Martinez-Carballeira, D, Mercadal, S, Hernandez-Rivas, JM, Vall-Llovera, F, Genesca, E, Cladera, A, Novo, A, Abella, E, Garcia-Cadenas, I, Monteserin, C, Bermudez, A, Piernas, S, Montesinos, P, Lopez, JL, Garcia-Guinon, A, Serrano, A, Martinez, MP, Olivares, M, Lopez, A, Serrano, J
Publicada:
1 ago 2020
Resumen:
In a series of 72 older and elderly frail patients (Charlson Comorbidity Index >= 4) with Philadelphia chromosome-negative acute lymphoblastic leukemia prospectively treated with a very attenuated chemotherapy regimen (vincristine, dexamethasone, methotrexate, and mercaptopurine) the rate of complete remission was 54%, with an overall survival probability of 7.6 months. Patients with an Eastern Cooperative Oncology Group score < 2 showed a better overall survival (median, 9 vs. 3 months). These results suggest that some of these patients could benefit from the concomitant or subsequent use of minimal chemotherapy, immunotherapy, and/or targeted therapy.
Background: The treatment of acute lymphoblastic leukemia (ALL) in older adults and elderly patients is a challenge, and modern protocols include targeted therapy and immunotherapy in combination with attenuated or minimal chemotherapy. However, frail patients are excluded from these trials, and reports on the outcome of this subgroup of patients are scarce. Our objective was to analyze the outcome of unfit older adults and elderly patients with Philadelphia chromosome-negative ALL included in a prospective trial (ALL-07FRAIL). Patients and Methods: Older adults and elderly patients with Charlson Comorbidity Index (CCI) >= 4 were included. Induction therapy consisted of vincristine and dexamethasone, and maintenance therapy with mercaptopurine and methotrexate for 2 years. Results: Seventy-two patients with a median age of 67 years (range, 57-89 years) and a median CCI of 5 (range, 4-12) were included. The rates of early withdrawal, early death, resistance, and complete response (CR) were 5%, 10%, 31%, and 54%, respectively. Six patients with CR abandoned the study, 5 died in CR, and 23 relapsed (cumulative relapse incidence 75%). The medians of disease-free and overall survival (OS) were 6.9 months (95% confidence interval [CI], 0.3-13.5 months) and 7.6 months (95% CI, 6.3-8.9 months), respectively. The most frequent toxic events were he- matologic (neutropenia 77% and thrombocytopenia 54%, of grade III-IV in all cases). Eastern Cooperative Oncology Group score but not the CCI had significant impact on OS. Conclusion: Complete remission with very attenuated chemotherapy can be attained in one-half of older or elderly infirm patients with ALL. These results suggest that some of these patients could benefit from the concomitant or subsequent use of immunotherapy and/or targeted therapy. (C) 2020 Elsevier Inc. All rights reserved.
Filiaciones:
Ribera, JM:
Univ Autonoma Barcelona, Josep Carreras Leukemia Res Inst IJC, Hematol Dept, ICO Hosp Germans Trias & Pujol, Badalona, Spain
Garcia, O:
Univ Autonoma Barcelona, Josep Carreras Leukemia Res Inst IJC, Hematol Dept, ICO Hosp Germans Trias & Pujol, Badalona, Spain
Chapchap, EC:
Albert Einstein Hosp, Hematol Dept, Sao Paulo, Brazil
Gil, C:
Hosp Gen Univ Alicante, Hematol Dept, Alicante, Spain
Gonzalez-Campos, J:
Hosp Univ Virgen Rocio, Hematol Dept, Seville, Spain
Barba, P:
Hosp Univ Vall dHebron, Hematol Dept, Barcelona, Spain
Amigo, ML:
Univ Morales Meseguer, Hematol Dept, Hosp Gen, Murcia, Spain
Moreno, MJ:
Hosp Clin, Hematol Dept, Malaga, Spain
Lavilla, E:
Hosp Lucus Augusti, Hematol Dept, Lugo, Spain
Alonso, N:
Complejo Hosp Univ, Hematol Dept, Santiago De Compostela, Spain
Bergua, JM:
Hosp San Pedro Alcantara, Hematol Dept, Caceres, Spain
Tormo, M:
Hosp Clin, Hematol Dept, Valencia, Spain
Ribera, J:
Univ Autonoma Barcelona, Josep Carreras Leukemia Res Inst IJC, Hematol Dept, ICO Hosp Germans Trias & Pujol, Badalona, Spain
Sierra, M:
Hosp Virgen Concha, Hematol Dept, Zamora, Spain
Martinez-Carballeira, D:
Hosp Cent Asturias, Hematol Dept, Oviedo, Spain
Mercadal, S:
Hosp Duran & Reynals, Hematol Dept, Inst Catala Oncol, Barcelona, Spain
Hernandez-Rivas, JM:
Hosp Univ Salamanca, Hematol Dept, Salamanca, Spain
Vall-Llovera, F:
Hosp Mutua Terrassa, Hematol Dept, Terrassa, Spain
Genesca, E:
Univ Autonoma Barcelona, Josep Carreras Leukemia Res Inst IJC, Hematol Dept, ICO Hosp Germans Trias & Pujol, Badalona, Spain
Cladera, A:
Hosp Univ Son Llatzer, Hematol Dept, Palma De Mallorca, Spain
Novo, A:
Hosp Univ Son Espases, Hematol Dept, Palma De Mallorca, Spain
Abella, E:
Hosp del Mar, Hematol Dept, Barcelona, Spain
Garcia-Cadenas, I:
Hosp Sant Pau, Hematol Dept, Barcelona, Spain
Monteserin, C:
Hosp Univ Getafe, Hematol Dept, Getafe, Spain
Bermudez, A:
Hosp Univ Marques Valdecilla, Hematol Dept, Santander, Spain
Piernas, S:
Consorci Corp Sanit Parc Tauli, Hematol Dept, Sabadell, Spain
Montesinos, P:
Hosp Univ & Politecn La Fe, Hematol Dept, Valencia, Spain
Lopez, JL:
Fdn Jimenez Diaz, Hematol Dept, Madrid, Spain
Garcia-Guinon, A:
Hosp Arnau Vilanova, Hematol Dept, Lleida, Spain
Serrano, A:
Hosp Madrid Norte Sanchinarro, Hematol Dept, Madrid, Spain
Martinez, MP:
Hosp Doce Octubre, Hematol Dept, Madrid, Spain
Olivares, M:
Hosp Galdakao, Hematol Dept, Galdakao, Spain
Lopez, A:
Hosp Arnau Vilanova, Hematol Dept, Valencia, Spain
Serrano, J:
Hosp Reina Sofia, Hematol Dept, Cordoba, Spain
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