Disease-free survival in patients over 40 years of age with phneg acute lymphoblastic leukemia treated with an intensive protocol

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Author: 
Alvarado Ibarra Martha, Ortiz Zepeda Maricela, Álvarez Vera José Luis, Mena Zepeda Verónica, Espitia Ríos María Eugenia, Jiménez Alvarado Rosa María and López Hernández Manuel
Subject Area: 
Health Sciences
Abstract: 

Introduction: Despitetheincreasingknowledgeabout acute lymphoblastic leukemia (ALL), the outcome for patients over 40 years of age is not good since they are generally too vulnerable to the toxicity caused by the chemotherapeutic protocols of the “pediatric type”. This group of patients usually tolerates less intensive protocols, but efficacy is diminished in terms of Survival Free of Leukemia. Objective: To determine the therapeutic results using a local, intensive protocol (LAL10), in patients with Phneg ALL that are older than 40 and are in a condition to receive intensive chemotherapy, treated in the hematology Service of the Centro MédicoNacional “20 de Noviembre” (National Medical Center) in Mexico City. Patients and Methods: From 2001 to 2015 an intensive chemotherapy program, with curative intent and designated as LAL10, was implemented in a High Specialization Center in Mexico City. The program was directed toward patients older than 40 with a de novo diagnosis of ALL, without an upper age limit. Patients were evaluated after the first dose of chemotherapy. Patients with previous use of anti-cancer agents or Ph+ were excluded. Those who abandoned treatment or went on to HPCT were eliminated. Results: Eighty-four patients who were in a condition to receive intensive chemotherapywere included. Medium age was 48 years with 26 patients older than 50 (31%). Female patients predominated. The frequency of complete remission was 74 (88%) and 10 patients were refractory. The most frequent event was relapse, constituting 47.6% of cases: 35 in bone marrow, 3 in skin and 2 in central nervous system. The probability for Leukemia-Free Survival to five years was 0.21 with a median of 14 months. The probability of Event-Free Survival was 0.17 with a median of 10 months. There were 32 deaths, 20 of which followed relapse or treatment failure and the other 12 happened between induction and up to the ninth month; the mode was 1 month. There were 7 deaths during induction. Causes of death were infection (24) and hemorrhage (8). The probability of OS at five years was 0.39 with a median of 25 months. Conclusion: In our experience, relapse was the most frequent event. Although this is not radically different from that observed in other studies on Phneg patients at comparable ages, these results are not considered to be satisfactory, especially when compared to results observed with the AYA group or in those younger than 15. Among the different protocols, chemotherapy usually includes the same drugs, although with different doses, and administration times and methods, but there is no indication of decisive beneficial changes.

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