PROGNOSTIC FACTORS IN ELDERLY ACUTE LYMPHOBLASTIC-LEUKEMIA

A retrospective study was performed on 46 unselected acute lymphoblast ic leukaemia (ALL) elderly patients aged 60 years or more. Only 50% of these patients were included in the EORTC cooperative clinical trials , thus confirming the important selection bias in most of the publishe d series on elderly ALL patients. 43% of the elderly patients achieved a complete remission (CR). The median survival was 10 months and the 5-year overall survival was only 7.6 +/- 4%. In multivariate analysis, W.H.O. performance status and peripheral blast counts at day 7 were f ound to significantly influence achievement of CR and survival. In pat ients with W.H.O. performance status greater than or equal to 2, 35% d ied during induction treatment versus 4% in patients with W.H.O, perfo rmance status <2. Patients >70 years old showed a marked drop of the C R rate (27%) compared to those aged 60-69 (67%), and a very high death rate during the induction period (38% versus 4%). This suggests that ALL protocol treatments should be proposed until 70 years in patients with good-performance status, whereas less intensive treatment should be offered to elderly patients with performance status greater than or equal to 2 and/or age greater than or equal to 70. Peripheral blast c ounts at day 7 may help to adjust the treatment during induction phase .