Pediatric-Inspired Therapy in Adults With Philadelphia Chromosome–Negative Acute Lymphoblastic Leukemia: The GRAALL-2003 Study

Abstract

These results suggest that pediatric-inspired therapy markedly improves the outcome of adult patients with ALL, at least until the age of 45 years.

Phase 2 study of intensified chemotherapy and allogeneic hematopoietic stem cell transplantation for older patients with acute lymphoblastic leukemia

“…30 Outcomes among older patients with ALL have only minimally improved in the last 2 decades, despite the progress in pediatric and younger adult ALL. 31 The intensification of chemotherapy regimens could lead to improved outcomes among older patients 32 , particularly those with Ph-disease.…”

Allogeneic transplantation is not superior to chemotherapy in most patients over 40 years of age with Philadelphia‐negative acute lymphoblastic leukemia in first remission

“…1 and 2; P value nonsignificant for both comparisons). The 3-year CIR and NRM were 61% [41-76] and 9% [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] for the chemotherapy-only group and 28% and 32% for the transplant group (Table II; Fig. 3; P 5 0.011 for CIR and P 5 0.014 for NRM).…”

“…Performance status and comorbidities affect patient eligibility for curative therapy and are associated with higher treatment-related mortality in those that are treated [4]. While more intensive, pediatricinspired approaches seem to have had a favorable impact on survival of young adults with ALL [5], these intense regimens cannot be safely applied in the majority of older patients [6]. ALL in the older population is usually enriched for high-risk cytogenetics and clinical features that translate into lower remission and higher relapse rates [7].…”

Intensive chemotherapy to improve outcome in patients with acute lymphoblastic leukemia over the age of 40: a phase II study for efficacy and feasibility by HOVON

“…1 --3 However, toxicity of these schedules seems prohibitive above the age of 40. 2 To improve the current dismal outlook for older patients, intensification of chemotherapy, although less stringent as in younger patients, may still be an option. A relatively intensive chemotherapeutic regimen that had already been applied successfully in both younger and older patients in a single center 4,5 seemed a promising approach for older patients.…”

“…In a small Spanish study in patients over 55 years, CR rate was 58% and early death rate 36%; 10 in the French GRAALL study with a pediatric schedule for patients up to 60 years without t(9;22), early death rate was 23% for patients over 45 years. 2 Stringent application of supportive care measures might reduce infectious complications and early treatment-related mortality. Furthermore, spacing between treatment courses to allow for better BM recovery could be beneficial.…”