Age but not Philadelphia positivity impairs outcome in older/elderly patients with acute lymphoblastic leukemia in Sweden

Research output: Contribution to journalArticle


Objectives: Older/elderly patients with acute lymphoblastic leukemia (ALL) are poorly represented in clinical trials. Methods: Using Swedish national leukemia registries, we investigated disease/patient characteristics, treatment choices, outcome, and the impact of an age-adapted protocol (introduced in 2009) in this population-based study of patients aged 55-85 years, diagnosed with ALL 2005-2012. Results: Of 174 patients, 82% had B-phenotype, 11% Burkitt leukemia (excluded), and 7% T-phenotype. Philadelphia chromosome positivity (Ph+) occurred in 35%. Of the 155 B- and T-ALL patients, 80% were treated with intensive protocols, and 20% with a palliative approach. Higher age and WHO performance status ≥2 influenced the choice of palliation. Intensive, palliative, and both approaches resulted in complete remission rate 83/16/70% and 3-year overall survival (OS) 32/3/26%. The age-adapted protocol did not improve outcome. With intensive treatment, platelet count ≤35×109/L and age ≥75 years were adverse prognostic factors for OS, Ph+ was not. Male sex was an adverse prognostic factor in the 55-64 year age-group. Conclusions: We report a high frequency of Ph+ in older/elderly patients, with no evidence of poorer outcome compared to Ph-negative disease. Overall prognosis for elderly patients with ALL remains dismal, despite the use of age-adapted treatment.


  • Piotr Kozlowski
  • Emma Lennmyr
  • Lucia Ahlberg
  • Per Bernell
  • Erik Hulegårdh
  • Holger Karbach
  • Karin Karlsson
  • Beata Tomaszewska-Toporska
  • Maria Åström
  • Heléne Hallböök
  • the Swedish Adult Acute Lymphoblastic Leukemia Group (SVALL)
External organisations
  • Örebro University
  • Uppsala University
  • Linköping University Hospital
  • Karolinska University Hospital
  • Sahlgrenska University Hospital
  • Norrland University Hospital
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Hematology


  • acute lymphoblastic leukemia, chemotherapy, elderly, epidemiology
Original languageEnglish
Pages (from-to)141-149
Number of pages9
JournalEuropean Journal of Haematology
Issue number2
Publication statusPublished - 2017 Aug 1
Publication categoryResearch