Acute lymphoblastic leukemia in elderly patients: a single institution's experience

Abstract

Background/aims: We investigated the clinical characteristics and prognosis of elderly patients with acute lymphoblastic leukemia (ALL).

Methods: We reviewed the clinical data, laboratory findings, bone marrow findings, and cytogenetic analysis of elderly patients (≥ 60 years) with ALL, and data of an additional 101 younger adult patients (< 60 years) with ALL were reviewed for comparison.

Results: Twenty-six elderly patients (≥ 60 years) and 101 younger adult patients (< 60 years) with ALL were retrospectively enrolled. The median follow-up duration was 6.0 months (range, 0.4 to 113.2) in the elderly patients and 21.7 months (range, 1.0 to 122.7) in the adult patients. In total, 34.6% (9 patients) of the elderly patients and 24.8% (25 patients) of the adult patients had Philadelphia chromosome positive ALL. The overall complete remission (CR) rate was much higher in the younger than in the elderly patients (94.1% vs. 57.7%, p < 0.001). The median overall survival (OS) of the younger patients (< 60 years) was 26.3 months, whereas that of the elderly patients (≥ 60 years) was 10.3 months (p = 0.003). In the elderly patients with ALL, T cell lineage and the presence of lymphadenopathy were significant prognostic factors for OS in a univariate analysis (p = 0.033 and 0.041, respectively).

Conclusions: The outcomes of Korean elderly patients with ALL were poor, and the shorter OS was mainly due to the low CR rate. T-cell lineage and the presence of lymphadenopathy were significant prognostic factors in Korean elderly patients with ALL.

Keywords: Aged; Leukemia, lymphoid; Philadelphia chromosome; Prognosis.

Figure 1

Treatment and outcomes of elderly patients with acute lymphoblastic leukemia (ALL). CR, complete remission; NST, non-myeloablative stem-cell transplantation.

Figure 2

Cumulative hazards of disease related and non-disease-related mortality in younger adult patients (< 60 yr) with acute lymphoblastic leukemia (ALL) and in elderly patients (≥ 60 yr) with ALL (p = 0.001 and 0.12, respectively).

Figure 3

(A) Overall survival (OS) of elderly and younger adult patients with acute lymphoblastic leukemia (ALL). Os of elderly patients with ALL (≥ 60 yr) was shorter than that of younger adult patients with ALL (< 60 yr) (median OS 10.3 mon vs. 26.3 mon, respectively, p = 0.003). (B) Os of the elderly and younger adult patients with Philadelphia chromosome (Ph)-negative ALL. Os of the elderly patients with Ph-negative ALL (≥ 60 yr) was shorter than that of adult patients with Ph-negative ALL (< 60 yr) (median OS, 10.3 mon vs. 29.2 mon, respectively, p = 0.01). (C) Os according to complete remission in elderly patients with ALL. Os of elderly patients with complete remission was longer than that of elderly patients without complete remission (median OS, 13.1 mon vs. 2.6 mon, p = 0.001) (D) Os according to age (60-69 yr vs. ≥ 70 yr) in elderly patients with ALL. Os of elderly patients aged 70 years or more was not significantly different from that of the other elderly patients (median OS, 11.2 mon vs. 3.7 mon, p = 0.073).