Acute lymphoblastic leukemia in the elderly

Abstract

We report our findings in 18 patients with acute lymphoblastic leukemia (ALL) aged 60 years or older. A preleukemic syndrome was observed in 2 patients. Compared to younger adults with ALL, L3 morphology was unexpectedly frequent (4/16) T‐ALL was not observed. Other criteria of poor prognosis (high white blood cell count, CNS involvement, organomegaly, high serum LDH) were similar to those reported in young adults. 12 patients were treated with an OPAL‐derived regimen, 4 with the MAV regimen, 1 with vincristine and prednisone, 1 with 6‐mercaptopurine. Complete remission was achieved in 8 patients but proved short‐lived. 5 patients died in aplasia and 5 failed to achieve remission. Median survival for the whole group was 3 months. ALL in the elderly raises the dilemma of an aggressive disease in patients with poor tolerance to intensive therapy.

A randomized study of pegylated liposomal doxorubicin versus continuous-infusion doxorubicin in elderly patients with acute lymphoblastic leukemia: the GRAALL-SA1 study

“…been due in part to the slight imbalance in favor of more T-ALL in the Peg-Dox arm, although this feature was not identified as a poor prognostic indicator in previous studies of ALL patients over 60 years old. 1,2,4,7,24,28,[30][31][32][33][34][35][36][37][38][39][40] Another explanation may be an incorrect calculation of the PegDox dose equivalence. As no pharmacokinetic studies were available comparing CI-Dox to Peg-Dox, the PegDox dose was defined according to the pivotal randomized study in metastatic breast cancer 15 and studies performed in high-grade non-Hodgkin's lymphoma 41,42 which applied a 1.2 dose reduction factor between conventional doxorubicin and Peg-Dox, the total conventional doxorubicin dose being divided over 4 days in the CI arm.…”

Two “childhood” malignancies in an elderly individual: a case report and discussion

“…The biological characteristics combined with the age and comorbidities appear to affect the outcome in the elderly population [8]. Studies among this age group have shown very poor prognosis, low remission and high relapse rates, shorter survival due to increased number of early deaths during induction chemotherapy and higher prevalence of disease refractory to standard chemotherapy [5][6][7].…”

“…B cell-ALL is more common, while T cell origin is rare and is associated with the presence of Philadelphia chromosome in half of the cases [6,7]. The biological characteristics combined with the age and comorbidities appear to affect the outcome in the elderly population [8].…”

Treatment of older patients with acute lymphoblastic leukemia

“…2,15,17,26,27,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] One central question is whether and/or which anthracycline has to be included in induction regimens for older patients, because these drugs contribute considerably to bone marrow toxicity. One approach is the use of idarubicin in induction, based on a potentially lower cardiac and hepatic toxicity.…”