Philadelphia chromosome-positive chronic myeloid leukemia in the elderly: presenting features, natural history and survival

BACKGROUND: Among patients with chronic myeloid leukaemia (CML) old people represent a minority whose disease characteristics are not well known. The aim of the study was to analyze the presenting features, the evolutive cour se, and the survival of older persons with Ph-positive CML, PATIENTS AND METHODS: Forty-four individuals > 65 years diagnosed with Ph-p ositive CML in a single centre were compared with 292 younger patients. RESULTS: Comparison of the presenting features of chronic phase Ph-positive CML patients yielded the following significant differences: predominance o f female sex (15 males/29 females versus 155/137; p = 0.02), higher proport ion of patients with anaemic syndrome (12% versus 2%; p = 0.001), lower fre quency of splenomegaly (41% versus 68%; p = 0.001), and higher serum levels of uric acid (p = 0.0006) in the older group. Although the latter patients survived significantly less (median survival 36.6 months, 95% CI: 27-46.2, versus 57.6 months, 95%: 51.2-64.1; p = 0.004), 9 of the 33 deaths registe red in this group (27%) occurred in the chronic phase of CML, versus 15 (9% ) of the 166 deaths in the younger group (p = 0.003). When chronic phase de aths were excluded and leukaemia-related deaths only considered (i.e,, thos e occurring in the BC or the accelerated phase of CML), old patients still had a shorter survival but the difference was no longer significant. CONCLUSIONS: Ph-positive CML features are essentially the same in older and young individuals, since most of the differences observed are attributable rather to the patients' advanced age than to the leukaemia itself.