Older Adults With Acute Lymphocytic Leukemia Continue to Face Challenges

Author’s Perspective

Study co-author Jae Park, MD: “[Older patients with ALL] require a careful evaluation of risks and benefits of each therapeutic option to select the appropriate treatment They should be referred to and evaluated at specialized centers where clinical trials are available and should be encouraged to participate in trials whenever possible.

Many challenges exist for these patients to participate in trials – sometimes as a result of limited social support and multiple medical comorbidities. Therefore, they require a multidisciplinary team of a primary-care physician (or geriatrician), medical specialists, social worker, and nurses to maximize therapeutic efficacy and improve long-term outcome.”


In an analysis of Surveillance, Epidemiology, and End Results (SEER) data published in Blood, Mark B. Geyer, MD, a senior clinical fellow in hematology and medical oncology at the Memorial Sloan Kettering Cancer Center in New York and co-authors found that, for older patients with acute lymphocytic leukemia (ALL), overall survival (OS) increased only slightly between 1980 and 2011. Dr. Geyer and researchers also highlighted the challenges that remain for this patient population – including increasing access to clinical trials.

The authors identified 12,891 patients from the database; 1,675 were ≥60 years old, diagnosed in 1980 or later, and had survival data available as of December 31, 2012 (data cutoff).

In the entire patient cohort, 1,517 deaths were recorded. Median OS was 4 months (range = 0-12 months), and three-year OS was 12.8 percent (95% CI 11.2-14.5), with a median follow-up among survivors of 26 months (range = 0-286 months).

Dr. Geyer and co-authors found several factors that were associated with worse prognosis, including time of diagnosis and location. Patients diagnosed between 2000 and 2011 had a 20 percent lower risk of mortality, compared with those who were diagnosed before 1990 (hazard ratio [HR] = 0.80; 95% CI 0.71-0.91; p<0.001), while patients who lived in the Northern Plains region had a 21 percent higher risk of mortality, compared with patients who lived in the eastern United States (HR=1.21; 95% CI 1.05-1.39; p=0.01). See TABLE for OS rates based on patient characteristics.

“Despite modest improvement in median OS among adults ≥60 years of age with ALL treated in 2000 to 2011 versus pre-1990, possibly reflecting improvements in supportive care (antibiotics, myeloid growth factors, anti-emetics), and tyrosine kinase inhibitor therapy for Philadelphia-positive ALL, rates of three-year OS remain decidedly poor,” the authors concluded.

The report is limited by its lack of data on individual patients’ disease characteristics and treatment, restricting the researchers’ ability to delineate the exact reasons for poor outcome in this patient population.

Source: Geyer MB, Hsu M, Devlin SM, et al. Overall survival among older U.S. adults with ALL remains low despite modest improvement since 1980: SEER analysis. Blood. 2017 January 25. [Epub ahead of print]

TABLE. Overall Survival Rates
Characteristic Strata Univariate Analysis Multivariate Analysis
  Median OS in months 3-year OS Hazard ratio p Value
Age at diagnosis 60-64 years 9

(95% CI 8-12)

24% 1 <0.0001
65-69 years 7

(95% CI 6-9)

17% 1.19

(95% CI 1.01-1.40)

70-74 years 5

(95% CI 3-6)

12% 1.46

(95% CI 1.23-1.73)

75-79 years 3

(95% CI 2-4)

8% 1.75

(95% CI 1.48-2.08)

80-84 years 1

(95% CI (1-2)

5% 2.18

(95% CI 1.82-2.62)

≥85 years 0

(95% CI 0-1)

4% 2.89

(95% CI 2.4-3.49)

Diagnosis year 1980-1989 3

(95% CI (2-4)

10% 1 <0.0001
1990-1999 2

(95% CI 2-3)

11% 1.06

(95% CI 0.93-1.21)

2000-2011 6

(95% CI 5-7)

16% 0.8

(95% CI 0.71-0.91)

Prior cancer history No 4

(95% CI 3-5)

13% 1 0.08
Yes 3

(95% CI 2-4)

10% 1.12

(95% CI 0.99-1.27)

Region East 6

(95% CI 4-7)

14% 1 0.04
Northern Plains 3

(95% CI 2-4)

11% 1.21

(95% CI 1.05-1.39)

Pacific Coast 4

(95% CI 3-5)

14% 1.05

(95% CI 0.91-1.21)

Southwest 4

(95% CI 2-7)

13% 1.14

(95% CI 0.95-1.36)

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