AGE-ADAPTED INDUCTION TREATMENT OF ACUTE LYMPHOBLASTIC-LEUKEMIA IN THE ELDERLY AND ASSESSMENT OF MAINTENANCE WITH INTERFERON COMBINED WITH CHEMOTHERAPY - A MULTICENTRIC PROSPECTIVE-STUDY IN 40 PATIENTS

Acute lymphoblastic leukemia (ALL) in the elderly is characterized by its poor prognosis. Forty patients with ALL, aged 55 years or older, a nd with good performance status (ECOG <3) were prospectively treated a ccording to an age-adapted regimen: induction therapy was derived from the LALA87 protocol while the feasibility of treatment with interfero n combined with chemotherapy was assessed during maintenance. Compared with younger adults treated according to the LALA87 protocol, elderly patients did not present with more adverse prognostic features, excep t for a lower incidence of T cell ALL (9 vs 31%, P = 0.005). There wer e even less patients with a high leukocyte count (15 vs 38%, P = 0.003 ), a characteristic associated with adverse prognosis while the incide nce of Philadelphia-positive (Ph-positive) ALL was not significantly i ncreased compared to younger adults (31 vs 20%, P = 0.2). After comple tion of induction therapy, with or without salvage treatment, 85% (CI: 70-94%) obtained a complete response (CR) while treatment-related mor tality during induction was 7.5% (CI: 2-20%). Median overall survival and disease-free survival were 14.3 months and 14 months, respectively , which, although inferior to results achieved in younger adults, comp ares favorably with available data in the elderly. Treatment with IFN proved feasible in most patients but had to be discontinued in eight p atients because of toxicity. Age-adapted treatment improves the progno sis of ALL in the elderly even if, in most cases, a cure cannot be ach ieved.