There has been an improvement in the prognosis of older patients diagnosed with acute lymphoblastic leukemia (ALL) in the last two decades, according to data presented at the 2022 American Society of Hematology Annual Meeting.
Varsha Gupta, MBBS, of Jersey Shore University Medical Center in Neptune, NJ, and colleagues explained that many of the substantial survival improvements seen in younger patients with ALL have not occurred in older patients due to varied genetic makeup and lower tolerance for aggressive treatment regimens.
However, some progress has been made among older patients with the development of novel therapeutics, including tyrosine kinase inhibitors (TKIs). To determine whether survival trends have improved in this older population of patients with ALL, Dr. Gupta and colleagues identified 26,801 patients with ALL from the Surveillance, Epidemiology, and End Results database for the period of 2000 to 2018.
Of the identified patients, about 10% were aged 65 years or older; 2,936 patients had the appropriate information for inclusion in the survival analysis.
During the study periods, survival among this elderly population improved. Compared with the reference period of 2000 to 2005, the hazard ratio (HR) for death improved from 0.75 for 2006 to 2011 to 0.65 for 2012 to 2018.
When the researchers looked at specific subgroups, they found that survival improved during these three time periods for the following patient cohorts:
- Aged 65 to 75 years
- Non-Hispanic white
- B-cell immunophenotype
There was also a significant improvement in survival among patients aged older than 75 years from 2000 to 2005 to 2012 to 2018; however, there was no improvement from 2006 to 2011 to 2012 to 2018.
For patients with T-cell immunophenotype, there was only improved survival from 2000 to 2005 to 2006 to 2011.
Overall, inferior survival outcomes were seen when ALL was diagnosed as a second malignancy (HR, 1.16; 95% CI, 1.07-1.27) and for Non-Hispanic Black patients (HR, 1.29; 95% CI, 1.09-1.52) compared with Non-Hispanic white patients.
Based on the findings of this study, the researchers concluded that there still remains an unmet need for effective treatments in racial minorities, patients aged older than 75 years, and those with T-cell immunophenotype.
Gupta V, Singh V, Jacob A, et al. Outcomes of elderly patients with acute lymphoblastic leukemia: trends of survival in the last two decades. Abstract #1379. Presented at the 64th American Society of Hematology Annual Meeting, December 10-13, 2022; New Orleans, Louisiana.