Survival of Adults with Acute Lymphoblastic Leukemia in Germany and the United States

Abstract

BackgroundAdulthood acute lymphoblastic leukemia (ALL) is a rare disease. In contrast to childhood ALL, survival for adults with ALL is poor. Recently, new protocols, including use of pediatric protocols in young adults, have improved survival in clinical trials. Here, we examine population level survival in Germany and the United States (US) to gain insight into the extent to which changes in clinical trials have translated into better survival on the population level.MethodsData were extracted from the Surveillance, Epidemiology, and End Results database in the US and 11 cancer registries in Germany. Patients age 15–69 diagnosed with ALL were included. Period analysis was used to estimate 5-year relative survival (RS).ResultsOverall 5-year RS was estimated at 43.4% for Germany and 35.5% for the US (p = 0.004), with a decrease in survival with increasing age. Survival was higher in Germany than the US for men (43.6% versus 37.7%, p = 0.002) but not for women (42.4% versus 40.3%, p>0.1). Five-year RS estimates increased in Germany and the US between 2002 and 2006 by 11.8 and 7.3 percent units, respectively (p = 0.02 and 0.04, respectively).ConclusionsSurvival for adults with ALL continues to be low compared with that for children, but a substantial increase in 5-year survival estimates was seen from 2002 to 2006 in both Germany and the US. The reasons for the survival differences between both countries require clarification.

CD19-targeted chimeric antigen receptor T-cell therapy for acute lymphoblastic leukemia

“…1 Improved survival primarily stems from decreased incidence of relapse, with very little improvement for more than 20 years in survival rates for children who relapse. [2][3][4] In contrast, overall survival for adults with ALL is quite poor (30% to 40%), 5,6 and relapsed ALL remains particularly challenging for all age groups, making it a leading cause of cancer deaths in children and carrying a dismal prognosis in adults. 2,4,7 Most children in first relapse will achieve a second complete remission (CR2), in contrast to the adult population, in which CR2 rates are 50% at best.…”

Isolated extramedullary cutaneous relapse despite concomitant severe graft-vs.-host disease and tissue chimerism analysis in a patient with acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation: A case report

“…However, relapse eventually occurs, and the 5 year overall survival (OS) is 42–63% for adolescents and young adults, 24.1% for patients between the ages of 40–59, and 17.7% for patients between the ages of 60–69 (5). Historically, age, a high leukocyte count at presentation, poor response to treatment, T-cell immunophenotype, cytogenetic profile of the disease and extranodal presentation of the disease have been considered adverse clinical prognostic factors in adult ALL.…”

Acute Lymphoblastic Leukemia, Version 2.2015

“…Adults have the poorest 5-year OS rate: 24.1% for patients between the ages of 40 and 59 and an even lower rate of 17.7% for patients between the ages of 60 and 69. 21 Although the exact OS percentage can vary based on how the age range is defined for pediatric, AYA, and adult patients, the trend is nonetheless clear that OS decreases substantially with increased age. The exception is infants younger than age 1, which is an age group that has not seen any improvement in survival over the past 30 years.…”