Acute lymphoblastic leukemia in the elderly: results of two different treatment approaches in 49 patients during a 25-year period.

This paper reported on a series of 49 elderly patients over 60 years of age affected by acute lymphoblastic leukemia (ALL), observed at our institution from 1969 to 1993. The biological characteristics considered, median WBC count, FAB classification, immunophenotype at onset of disease, were no different from those of our adult ALL series. Overall complete remission (CR) rate of these patients was 59%, 18% had resistant disease and 23% died during induction. Overall median survival was 9 months and overall median duration of CR was 7 months. All patients were divided according to treatment into two groups: group A (13 patients) received an intensive treatment including vincristine (VCR), prednisone (PDN), daunorubicin (DNR) and L-asparaginase (L-Asp), while in group B (36 patients) were included patients who received mild conventional induction with VCR and PDN. In group A, 77% of patients achieved CR and 23% died during induction. All patients were hospitalized during induction treatment. During follow-up, among 10 CRs, five (50%) died in CR because of hemorrhage (two), infections (two) and myocardial infarction (one); five (50%) relapsed. Median survival was 4 months and median duration of CR was 3.5 months. In group B, 53% of patients obtained CR, 25% had resistant disease and 22% died during induction. During induction, 44% of patients were hospitalized. During follow-up, among 19 CRs, 14 (74%) relapsed and three (15%) died in CR because of infection (two) and cardiorespiratory failure (one). Three patients (15%) are still alive: two in first CR and one in second CR. No statistical differences between the two groups in terms of CR rate or survival were noted. Standardized therapeutic trials are needed better to evaluate results in these patients, considering also the introduction of new therapeutic agents or supportive treatments, such as growth factors.