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High Induction Response Rate, but Poor Long-Term Disease Free Survival in Elderly Patients Treated Aggressively for Acute Lymphoblastic Leukemia

Adisak Tantiworawit, Walaa A Rajkhan, Michael J Barnett, John D Shepherd, Alina S Gerrie, Raewyn Broady, Donna L Forrest , Donna E Hogge, Stephen H Nantel, Sujaatha Narayanan, Thomas J Nevill, Maryse M Power, Heather J Sutherland, Cynthia L Toze, Kevin W Song and Yasser R Abou Mourad

Elderly Acute Lymphoblastic Leukemia (ALL) patients are routinely offered palliative chemotherapy and best supportive care. Few studies have addressed their outcome with aggressive chemotherapy. We pursued this population based study to address the outcome of ALL patients older than 60 years treated with aggressive chemotherapy. We reviewed 32 consecutive patients treated with aggressive chemotherapy between 1989 and 2008. Twenty-seven patients (84.4%) achieved Complete Remission (CR) to induction chemotherapy of whom 23 patients (85.2%) had disease relapse. Median time to relapse was 8 (3.7-44) months. Median disease free survival and overall survival were 10.4 (0-43.9) and 16.3 (1.3-59) months, respectively. Cause of death was disease progression in 25/27 (92.6%). Seven patients (21.8%) had Philadelphia chromosome positive (Ph+) disease. Six out of these seven patients received combination chemotherapy with a tyrosine kinase inhibitor. The 3-year overall survival for the whole group was 26%; 36% for Ph+ and 23% Ph- patients. Despite the high CR rate, relapse remains inevitable and most patients died secondary to relapse. Prospective randomized studies are needed to identify the role of reduced intensity stem cell transplantation or other consolidation therapy for this dreadful disease in this age group.