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Master Thesis

Consolidations intensives dans la leucémie aiguë lymphoblastique du sujet âgé : une étude rétrospective

Abstract : Background: over 20% of adult acute lymphoblastic leukemia (ALL) occur after the age of 60. The improvements observed with pediatric-inspired regimen in the past decade in adults do not translate in this older population with increased treatment related toxicity and early deaths. The European Working Group for Adult ALL (EWALL) backbone, adapted for elderly patients, reported a poor 3 years overall survival of about 24% due to high relapse rates. Our center reports the outcome of a regimen designed to improve the outcome of the EWALL backbone and retrospectively compared it to an historical cohort. Methods: the experimental regimen associated the first part of the induction course of the EWALL backbone with a post-induction phase including three age-adapted consolidation courses and a late intensification according to the GRAALL-2005 protocol. Results: twenty-four patients were included in the study. Median age was 67 [IQR: 64-71]. Complete remission (CR) rate was 81% in the experimental cohort. All patients in CR (19) were eligible to intensive consolidations and late intensification and 16 (84%) reached maintenance phase. Major toxicities during pediatric-inspired consolidation courses included infections (9 patients, including three with bacteremia, two with pyelonephritis and one with pneumonia), grade 3-4 liver toxicity (6), acute kidney failure (3) and hyperglycemia requiring insulin (1). No death was observed during consolidations or late intensification. The median follow-up times were 2,6 years and 8,2 years for the experimental cohort and the historical cohort, respectively. The experimental regimen translated into a significantly longer two years disease-free survival (57% [CI95% 31-76] vs 29% [CI95% 11-51] p=0.007 by log-rank test). Conclusion: results presented here strongly suggest that an intensified protocol after an age-adapted induction course is tolerable and might yield better results than former protocols in older adults with Ph-negative ALL.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01624652
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Submitted on : Thursday, October 26, 2017 - 3:55:23 PM
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François-Xavier Gros. Consolidations intensives dans la leucémie aiguë lymphoblastique du sujet âgé : une étude rétrospective. Médecine humaine et pathologie. 2017. ⟨dumas-01624652⟩

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