The impact of age on outcome in lymphoblastic leukaemia; MRC UKALL X and XA compared: a report from the MRC Paediatric and Adult Working Parties

Abstract

The purpose of the study was to examine the influence of age on outcome in a large cohort of children and adults with lymphoblastic leukaemia who were treated on two similar trials. Factors influencing outcome were examined in 2204 patients aged over 1 year treated between 1985 and 1992 on the parallel Medical Research Council Trials UKALL X and Xa, for children and adults, respectively. There was a progressive worsening in survival with increasing age from 85% (95% CI 83-87) at 5 years for children aged 1-9 to 24% (CI 17-31) for patients over 40. Induction failures, deaths in remission and bone marrow relapses increased significantly with age. Analysis of clinical and biological features showed dominance of early B-ALL in childhood and increasing incidence of the PhЈ chromosome with age. Over 80% of eligible children, but a much lower proportion of adults especially those over 40, was entered. Compliance was stricter in the paediatric trial but most deviations in adults involved giving more treatment. Analysis of results in a proportional hazards model confirmed the overwhelming independent influence of age; with all other factors equal a 10 year old had half the risk of treatment failure of a 20 year old and a 44 year old double the risk. Selective entry to therapeutic trials and increased treatment-related toxicity are features of adult ALL but age itself remains a dominant prognostic factor. While improved supportive care and refinements of conventional therapy may have some effect on prognosis, new understandings and treatment approaches to adult ALL are needed.

A genome-wide association study of susceptibility to acute lymphoblastic leukemia in adolescents and young adults

“…4,5 The inferior prognosis of AYA is likely to be multifactorial and includes socioeconomic factors, medication adherence, clinical trial enrollment and, importantly, age-related differences in ALL tumor and host biology. 6 For example, as age increases, there is a progressive rise in prevalence of ALL genetic subtypes with poor prognosis such as Philadelphia chromosome-positive (Ph1), 7 Ph-like, 8 or intrachromosomal amplification of chromosome 21, 9 whereas subtypes with favorable outcome (high hyperdiploidy 10 and ETV6-RUNX1…”

HLA-identical haematopoietic stem cell transplantation for acute leukaemia in children: less relapse with higher biologically effective dose of TBI

“…When corrected for all possible influencing factors, a 20-year-old had a twofold higher risk of treatment failure than a 10-year-old patient. 43 Studies on the influence of age on the outcome of allogeneic SCT for ALL and AML report conflicting data. Some reports find that survival is better in younger patients and some find no influence of age on survival.…”

Immunophenotypic Profile in Adult Patients with Acute Leukemia Association with Clinical Feature: Fluorescence Cytometry Quantitative Analysis

“…B-ALL T-ALL previous studies, where male gender ranged from 59% to 63% [12] incidence of all was common in young, while incidence of AML was common in adult [8].…”