ACUTE LYMPHOBLASTIC-LEUKEMIA IN THE ELDERLY

Acute lymphoblastic leukaemia (ALL) is rare in adults over the age of 60 years, with an incidence of 1 per 100,000 per year. We review the c urrent (sparse) literature and our Regional experience of 62 consecuti ve cases of ALL in this age group collected over a ten year period. Th e patterns of cytogenetic abnormalities and immunophenotypes differs f rom those seen in ALL in childhood and young adults, but are similar t o those reported in previous studies. B-ALL was found at twice the rat e observed in younger adults (9/51 versus 6/99) and TALL was rare (2/5 1). In our patients we had few cytogenetic results but in the literatu re up to 50% of patients have been found to be Philadelphia positive, supporting the hypothesis that ALL in this group is often a stem cell disorder. In our patients treatment results were disappointing, with o nly 30% of those given 'curative' treatment achieving a complete remis sion, and a relapse rate of 92%, mirroring other published series. The overall four year survival was 4%. We conclude that ALL in the elderl y is a rare condition with an extremely poor prognosis. Aggressive tre atment may prolong life but it seldom cures.