AGE-ADAPTED MODERATE-DOSE INDUCTION AND FLEXIBLE OUTPATIENT POSTREMISSION THERAPY FOR ELDERLY PATIENTS WITH ACUTE LYMPHOBLASTIC-LEUKEMIA

We report the results of a recent trial in elderly acute lymphoblastic leukemia (ALL) patients (greater than or equal to 60 years). Initial chemotherapy consisted of one 14-day course with single-dose idarubici n plus vincristine-prednisone-L-asparaginase. Idarubicin was preferred to other anthracyclines because of its shorter time to response. Sequ ential outpatient postremission therapy included single-dose idarubici n plus vincristine-cyclophosphamide-L-asparagin pulses, cranial irradi ation with intrathecal methotrexate-cytarabine, flexible weekly vincri stine-cyclophosphamide alternating with cytarabine-teniposide, and two -year standard maintenance with mercaptopurine-methotrexate. Granulocy te colony-stimulating factor (G-CSF) was added to induction and early consolidation courses. Twenty-two patients mainly with high-risk featu res entered the study: median age was 64 years (60-73), 40% of cases w ere CD 10(-) B-lineage and T-lineage ALL, 38% of CD10(+) B-lineage ALL carried a BCR-ABL rearrangement, while 23% coexpressed myeloid antige n, 86% had L2 morphology, 50% had a blast count greater than 10 x 10(9 )/1, 54% had hepato-splenomegaly and lymphadenopathy. The complete rem ission (CR) rate after induction therapy was 59%. A partial remission was obtained in two cases. There were four early deaths (18%) and thre e refractory ALL (14%). Median time to response was 21 days. With G-CS F, the median duration of absolute neutropenia was 10.5 days. Flexible postremission therapy was very well tolerated, causing no major toxic ity. With a median follow-up of 2.6 years, 3 patients remain alive in first CR (23%), 2 of whom at 21.3 months and 39.6 months, respectively . Median survival of responders was 12 months compared to only 1.2 mon ths for nonresponders (p < 0.001). This moderate-dose idarubicin-conta ining and G-CSF-supported regimen was associated with a high early rem ission rate in elderly ALL. Postremission therapy results were modest, though not appreciably different from the general experience in this patient population. Because further escalation of drug intensity appea rs unjustified, attempts to document and reverse drug resistance patte rns and restore a dysregulated apoptosis must be considered.