EFFECT OF AGE ON SURVIVAL IN ACUTE-LEUKEMIA - 1950-1990

Background. Four decades ago, survival of patients with acute leukemia was brief at any age. Since 1950, survival of children has increased remarkably but has changed little for the elderly. The nature and magn itude of this age difference in survival are not understood. Methods. Median survival was determined in 2364 Kansas residents diagnosed with acute leukemia from 1947 until 1990. Of this number, 1032 had acute l ymphocytic leukemia and 1227 had acute myelocytic leukemia diagnosed b etween 1950 and 1989. These patients were stratified by age and decade of diagnosis. Survival was computed by life-table analysis with signi ficance determined by log-rank, Wilcoxon, and Fisher exact tests. Resu lts. During the 40 years of the study, highly significant increases oc curred in median survivals for all groups with either acute lymphocyti c leukemia or acute myelocytic leukemia occurring in patients younger than 60 years of age (P < 0.0001 for some age groups), but no signific ant increases for those 61 to 80 years of age and those 81 years of ag e and older. Viewed in another dimension, for each decade from the 196 0s to the present in acute lymphocytic leukemia and from the 1970s to the present in acute myelocytic leukemia, age at diagnosis was inverse ly correlated with median survival in a highly significant manner (P < 0.001). Conclusions. Increasing age is inversely related to survival in patients with acute leukemia. The lack of significant improvement i n median survival in the last 40 years for those older than 60 years o f age stands in stark contrast to the remarkable improvement for young er patients. Acute leukemia in older patients demands new and probably different therapeutic strategies.