Acute lymphoblastic leukemia in the elderly: The Edouard Herriot Hospital experience

Data on all patients with acute lymphoblastic leukemia (ALL) aged 60 or old er, referred to our institution over a 18-year period, were studied to dete rmine the incidence and range of clinical and biological subtypes, and the outcome of different therapeutic approaches. Sixty-nine ALL cases (median a ge: 68 years) were diagnosed between 1980 and 1998 (18% of all adult ALL se en during this period). Ten of them (14%) had a past history of previous ma lignancy. Karyotypic analysis was performed successfully in 42 cases. Ten p atients were diagnosed as Philadelphia chromosome positive (Ph+) ALL, Immun ophenotyping was performed in 63 cases. Fifty-six patients had B-cell linea ge ALL. T lymphoid markers were observed only in 5 cases. Co-expression of myeloid markers was observed in 19% of tested cases. Five patients died bef ore any chemotherapy could be given. All other patients received "curative" treatment according to different protocols used during the period of study . Overall complete remission (CR) rate of these patients was 62% (95% confi dence interval (CI): 50-74%). Thirty-nine patients achieved CR after one co urse of chemotherapy and 4 patients after salvage therapy. Median disease-f ree survival (DFS) of the entire cohort was 8.3 months (95% GI: 5-12.8 mont hs) and median overall survival was 7 months (95% CI: 6-10 months). In mult ivariate analysis, the presence of hemorrhage (P = 0.02) was a poor prognos tic for CR achievement. Higher WHO performance status (P = 0.003) and the p resence of hemorrhage (P = 0.01) at diagnosis were poor prognostics for ove rall survival. When patients were stratified into three groups according to the time of admission, survival appeared significantly longer for patients admitted between July 1992 and December 1998 (median overall survival at 1 0 months) than for patients admitted before July 1992 (P = 0.04), "Age-adap ted" therapy appeared superior to "young adult-like" therapy in terms of CR rate (96% versus 60%; P = 0.007). However, "age-adapted" therapy did not s how any advantage in terms of DFS or overall survival, making the differenc e in CR rates questionable. We conclude that the pejorative overall outcome in elderly ALL points to the need for new therapeutic trials taking into a ccount the specific characteristics of ALL in this age group. Am. J. Hemato l. 67:73-83, 2001. (C) 2001 Wiley-Liss, Inc.