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Publications (7 of 7) Show all publications
Lennmyr, E., Karlsson, K., Ahlberg, L., Garelius, H., Hulegardh, E., Izarra, A. S., . . . Hallböök, H. (2019). Survival in adult acute lymphoblastic leukaemia (ALL): A report from the Swedish ALL Registry. European Journal of Haematology, 103(2), 88-98
Open this publication in new window or tab >>Survival in adult acute lymphoblastic leukaemia (ALL): A report from the Swedish ALL Registry
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2019 (English)In: European Journal of Haematology, ISSN 0902-4441, E-ISSN 1600-0609, Vol. 103, no 2, p. 88-98Article in journal (Refereed) Published
Abstract [en]

Objectives: As new, effective therapies emerge for acute lymphoblastic leukaemia (ALL), the results of clinical trials need to relate to standard of care.

Methods: We used the population-based Swedish ALL Registry to evaluate characteristics, treatment and long-term outcome in 933 patients with diagnosis between 1997 and 2015.

Results: The median age was 53 years. The frequency of Philadelphia (Ph)-positive leukaemia was 34% of examined B-ALL with a peak incidence at 50-59 years. Five-year overall survival (OS) improved between 1997-2006 and 2007-2015; in patients 18-45 years from 50% (95% CI 43-57) to 65% (95% CI 58-72), 46-65 years from 25% (95% CI 18-32) to 46% (95% CI 37-55) and >65 years from 7% (95% CI 2.6-11) to 11% (95% CI 5.9-16) (P < 0.05). Men with Ph-neg B-ALL 46-65 years had inferior OS compared with women (P < 0.01). Standardised mortality ratio was 5.7 (95% CI 5.0-6.3) for patients who survived 5 years from diagnosis. In multivariable analysis, Ph-positive disease was not associated with impaired prognosis but with lower risk of death in 2007-2015.

Conclusions: In a population-based cohort, OS has improved in adult ALL, especially for Ph-positive disease but for middle-aged men with Ph-negative B-ALL outcome was poor. Cure without late toxicity or relapse is still desired.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
acute lymphoblastic leukaemia, adult, Philadelphia-positive
National Category
Hematology
Identifiers
urn:nbn:se:uu:diva-390495 (URN)10.1111/ejh.13247 (DOI)000475475200003 ()31074910 (PubMedID)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-09-17Bibliographically approved
Lennmyr, E. B., Kozlowski, P., Ahlberg, L., Bernell, P., Hulegardh, E., Izarra, A. S., . . . Hallböök, H. (2018). Real-world data on first relapse of acute lymphoblastic leukemia in patients > 55 years [Letter to the editor]. Leukemia and Lymphoma, 59(10), 2470-2473
Open this publication in new window or tab >>Real-world data on first relapse of acute lymphoblastic leukemia in patients > 55 years
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2018 (English)In: Leukemia and Lymphoma, ISSN 1042-8194, E-ISSN 1029-2403, Vol. 59, no 10, p. 2470-2473Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Taylor & Francis Group, 2018
National Category
Cancer and Oncology Hematology
Identifiers
urn:nbn:se:uu:diva-374878 (URN)10.1080/10428194.2017.1416369 (DOI)000455166400026 ()29345172 (PubMedID)
Funder
Thuréus stiftelse för främjande av geriatrisk forskningErik, Karin och Gösta Selanders Foundation
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-01-24Bibliographically approved
Kozlowski, P., Lennmyr, E., Ahlberg, L., Bernell, P., Hulegårdh, E., Karbach, H., . . . Hallböök, H. (2017). Age but not Philadelphia positivity impairs outcome in older/elderly patients with acute lymphoblastic leukemia in Sweden. European Journal of Haematology, 99(2), 141-149
Open this publication in new window or tab >>Age but not Philadelphia positivity impairs outcome in older/elderly patients with acute lymphoblastic leukemia in Sweden
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2017 (English)In: European Journal of Haematology, ISSN 0902-4441, E-ISSN 1600-0609, Vol. 99, no 2, p. 141-149Article in journal (Refereed) Published
Abstract [en]

ObjectivesOlder/elderly patients with acute lymphoblastic leukemia (ALL) are poorly represented in clinical trials. MethodsUsing 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 55-85years, diagnosed with ALL 2005-2012. ResultsOf 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 35x10(9)/L and age 75years were adverse prognostic factors for OS, Ph+ was not. Male sex was an adverse prognostic factor in the 55-64 year age-group. ConclusionsWe 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.

Place, publisher, year, edition, pages
WILEY, 2017
Keywords
acute lymphoblastic leukemia, chemotherapy, elderly, epidemiology
National Category
Hematology
Identifiers
urn:nbn:se:uu:diva-329913 (URN)10.1111/ejh.12896 (DOI)000404936400005 ()
Available from: 2017-10-20 Created: 2017-10-20 Last updated: 2017-10-20Bibliographically approved
Ungerstedt, J., Eriksson, A., Olander, E., Bergfelt, E., Liljeholm, M., Kristjanssdottir, H. L., . . . Birgegård, G. (2015). Development of a Progress Test Based on the EHA Curriculum and EHA CV Passport, Used for Yearly Evaluation of Hematology Residency In Sweden. Paper presented at 20th Congress of European-Hematology-Association, JUN 11-14, 2015, Vienna, AUSTRIA. Haematologica, 100, 776-776
Open this publication in new window or tab >>Development of a Progress Test Based on the EHA Curriculum and EHA CV Passport, Used for Yearly Evaluation of Hematology Residency In Sweden
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2015 (English)In: Haematologica, ISSN 0390-6078, E-ISSN 1592-8721, Vol. 100, p. 776-776Article in journal, Meeting abstract (Other academic) Published
National Category
Hematology
Identifiers
urn:nbn:se:uu:diva-266180 (URN)000361204904518 ()
Conference
20th Congress of European-Hematology-Association, JUN 11-14, 2015, Vienna, AUSTRIA
Available from: 2015-11-06 Created: 2015-11-05 Last updated: 2017-12-01Bibliographically approved
Bergfelt, E., Kozlowski, P., Astrom, M., Ahlberg, L., Bernell, P., Hulegardh, E., . . . Hallböök, H. (2015). PROGNOSIS IN OLDER/ELDERLY PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKAEMIA DIAGNOSED 2005-2012: RESULTS FROM A SWEDISH POPULATION-BASED STUDY. Paper presented at 20th Congress of European-Hematology-Association, JUN 11-14, 2015, Vienna, AUSTRIA. Haematologica, 100, 202-202
Open this publication in new window or tab >>PROGNOSIS IN OLDER/ELDERLY PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKAEMIA DIAGNOSED 2005-2012: RESULTS FROM A SWEDISH POPULATION-BASED STUDY
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2015 (English)In: Haematologica, ISSN 0390-6078, E-ISSN 1592-8721, Vol. 100, p. 202-202Article in journal, Meeting abstract (Other academic) Published
National Category
Hematology
Identifiers
urn:nbn:se:uu:diva-266172 (URN)000361204902037 ()
Conference
20th Congress of European-Hematology-Association, JUN 11-14, 2015, Vienna, AUSTRIA
Available from: 2015-11-09 Created: 2015-11-05 Last updated: 2017-12-01Bibliographically approved
Bergfelt, E., Kozlowski, P., Ahlberg, L., Hulegardh, E., Hagglund, H., Karlsson, K., . . . Hallböök, H. (2015). Satisfactory outcome after intensive chemotherapy with pragmatic use of minimal residual disease (MRD) monitoring in older patients with Philadelphia-negative B cell precursor acute lymphoblastic leukaemia: a Swedish registry-based study. Medical Oncology, 32(4), Article ID 135.
Open this publication in new window or tab >>Satisfactory outcome after intensive chemotherapy with pragmatic use of minimal residual disease (MRD) monitoring in older patients with Philadelphia-negative B cell precursor acute lymphoblastic leukaemia: a Swedish registry-based study
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2015 (English)In: Medical Oncology, ISSN 1357-0560, E-ISSN 1559-131X, Vol. 32, no 4, article id 135Article in journal (Refereed) Published
Abstract [en]

The introduction of minimal residual disease (MRD) monitoring, in the Swedish national guidelines for acute lymphoblastic leukaemia, was evaluated in 35 patients aged 46-79 years (median 61), who were diagnosed from 2007 to 2011 and treated with high-intensity, block-based chemotherapy (ABCDV/VABA induction). Both a high complete remission rate (91 %) and acceptable overall survival (OS) rate (47 %) at 5 years were achieved. MRD by flow cytometry was measured in 73 % of the patients reaching complete remission after the first course, but was omitted by the clinicians for eight patients who were either over 70 years of age or already met conventional high-risk criteria. Factors negatively influencing OS were age over 65 years and WHO status >= 2. MRD < 0.1 % after induction had positive impact on continuous complete remission but not on OS. Only five patients were allocated to allogeneic haematopoietic stem cell transplantation in first remission, mainly due to conventional high risk factors. Thus, use of intensive remission induction therapy is effective in a selection of older patients. In a population for whom the possibilities of treatment escalation are limited, the optimal role of MRD monitoring remains to be determined.

Keywords
Acute lymphoblastic leukaemia, Adults, Minimal residual disease, Flow cytometry
National Category
Cancer and Oncology Immunology in the medical area
Identifiers
urn:nbn:se:uu:diva-258836 (URN)10.1007/s12032-015-0582-2 (DOI)000351474100049 ()25796502 (PubMedID)
Available from: 2015-07-23 Created: 2015-07-20 Last updated: 2018-01-11Bibliographically approved
Bergfelt, E., Kozlowski, P., Ahlberg, L., Hulegardh, E., Hägglund, H., Karlsson, K., . . . Hallböök, H. (2014). Minimal Residual Disease in Adults with Philadelphia Negative B-Cell Precursor Acute Lymphoblastic Leukemia a Swedish Population-Based Study. Paper presented at 19th Congress of the European-Hematology-Association, JUN 12-15, 2014, Milan, ITALY. Haematologica (online), 99(S1), 279-280
Open this publication in new window or tab >>Minimal Residual Disease in Adults with Philadelphia Negative B-Cell Precursor Acute Lymphoblastic Leukemia a Swedish Population-Based Study
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2014 (English)In: Haematologica (online), ISSN 0390-6078, E-ISSN 1592-8721, Vol. 99, no S1, p. 279-280Article in journal, Meeting abstract (Other academic) Published
National Category
Hematology
Identifiers
urn:nbn:se:uu:diva-236805 (URN)000342830901220 ()
Conference
19th Congress of the European-Hematology-Association, JUN 12-15, 2014, Milan, ITALY
Available from: 2014-11-28 Created: 2014-11-24 Last updated: 2017-12-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1737-5568

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