ACUTE LYMPHOBLASTIC-LEUKEMIA IN THE ELDERLY - RESULTS OF 2 DIFFERENT TREATMENT APPROACHES IN 49 PATIENTS DURING A 25-YEAR PERIOD

This paper reported on a series of 49 elderly patients over 60 years o f age affected by acute lymphoblastic leukemia (ALL), observed at our Institution from 1969 to 1993. The biological characteristics consider ed, median WBC count, FAB classification, immunophenotype at onset of disease, were no different from those of our adult ALL series. Overall complete remission (CR) rate of these patients was 59%, 18% had resis tant disease and 23% died during induction. Overall median survival wa s 9 months and overall median duration of CR was 7 months. All patient s were divided according to treatment into two groups: group A (13 pat ients) received an intensive treatment including vincristine (VCR), pr ednisone (PDN), daunorubicin (DNR) and L-asparaginase (L-Asp), while i n group B (36 patients) were included patients who received mild conve ntional induction with VCR and PDN. In group A, 77% of patients achiev ed CR and 23% died during induction. All patients were hospitalized du ring induction treatment. During follow-up, among 10 CRs, five (50%) d ied in CR because of hemorrhage (two), infections (two) and myocardial infarction (one); five (50%) relapsed. Median survival was 4 months a nd median duration of CR was 3.5 months. In group B, 53% of patients o btained CR, 25% had resistant disease and 22% died during induction. D uring induction, 44% of patients were hospitalized. During follow-up, among 19 CRs, 14 (74%) relapsed and three (15%) died in CR because of infection (two) and cardiorespiratory failure (one). Three patients (1 5%) are still alive: two in first CR and one in second CR. No statisti cal differences between the two groups in terms of CR rate or survival were noted. Standardized therapeutic trials are needed better to eval uate results in these patients, considering also the introduction of n ew therapeutic agents or supportive treatments, such as growth factors .