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Acute lymphoblastic leukemia in patients over 59 years of age

Experience in a single center over a 10-year period

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Summary

We report data of 29 consecutive patients aged 60 years or older with newly diagnosed acute lymphoblastic leukemia (ALL) treated at a single center between 1983 and 1992. Immunophenotyping was performed in 26 patients. According to the immunological classification used at the time of diagnosis, 14 had common-ALL, two had T-ALL, six had null-ALL, three had myeloid antigen-positive ALL with both lymphoid and myeloid markers, and one had B-ALL. One patient died before therapy could be instituted. Twenty-four patients received intensive induction chemotherapy. Nine of these patients died during the first 8 weeks, eight due to infections and one due to liver failure after asparaginase. In 14 of the remaining patients treated intensively, scheduled treatment was discontinued prematurely due to treatment-related toxicity and was replaced by milder chemotherapy. Four patients aged 75–77 years were treated with vincristine and prednisone. Only one patient who completed a whole study protocol survived more than 5 years. Twelve of the 28 patients treated with chemotherapy achieved complete remissions. The median survival was 5 months (range 1–103+). Median survival in patients with CR was 9.0 months. Actuarial survival is 3%. Our data demonstrate a poor prognosis in ALL patients over 59 years of age. The reasons were a high mortality during intensive induction therapy due to toxicity of treatment and a short remission duration.

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References

  1. Baccarani M, Corbelli G, Amadori S, Drenthe-Schonk A, Willemze R, Meloni G, Lopez Cordazo P, Haanen C, Mandelli F, Tura S (1982) Adolescent and adult lymphoblastic leukemia: prognostic features and outcome of therapy. A study of 293 patients. Blood 60:677–684

    PubMed  Google Scholar 

  2. Barnett MJ, Greaves MF, Amess JA, Gregory WM, Rohatiner AZ, Dhaliwal HS, Slevin ML, Biruls R, Malpas JS, Lister TA (1986) Treatment of acute lymphoblastic leukemia in adults. Br J Haematol 64:455–468

    PubMed  Google Scholar 

  3. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, Sultan C (1976) Proposals for the classification of the acute leukemias. Br J Haematol 33:451–458

    PubMed  Google Scholar 

  4. Bernstein SH (1993) Growth factors in the management of adult acute leukemia. Hematol Oncol Clin North Am 7:255–274

    PubMed  Google Scholar 

  5. Champlin R, Gale RP (1989) Acute lymphoblastic leukemia recent advances in biology and therapy. Blood 73:2051–2066

    PubMed  Google Scholar 

  6. Delannoy A, Ferrant A, Bosly A, Chatelain C, Doyen C, Martiat P, Michaux JL, Sokal G (1990) Acute lymphoblastic leukemia in the elderly. Eur J Haematol 45:90–93

    PubMed  Google Scholar 

  7. Ellison RR, Mick R, Cuttner J, Schiffer CA, Silver RT, Henderson ES, Woliver T, Royston I, Davey FR, Glicksman AS, Bloomfield CD, Holland JF (1991) The effects of postinduction intensification treatment with cytarabine and daunorubicin in adult acute lymphocytic leukemia a prospective randomized clinical trial by cancer and leukemia: group B. J Clin Oncol 9:2002–2015

    PubMed  Google Scholar 

  8. Gaynor J, Chapman D, Little C, McKenzie S, Miller W, Andreeff M, Arlin Z, Berman E, Kempin S, Gee T, Clarkson B (1988) A cause-specific hazard rate analysis of prognostic factors among 199 adults with acute lymphoblastic leukemia the Memorial Hospital experience since 1969. J Clin Oncol 6:1014–1030

    PubMed  Google Scholar 

  9. Götz G, Weh HJ, Walter TA, Kuse R, Kolbe K, Hellriegel KP, Hoelzer D, Hossfeld DK (1992) Clinical and prognostic significance of the Philadelphia chromosome in adult patients with acute lymphoblastic leukemia. Ann Hematol 64:97–100

    PubMed  Google Scholar 

  10. Hoelzer D (1993) Acute lymphoblastic leukemia — progress in children, less in adults. N Engl J Med 329:1343–1344

    PubMed  Google Scholar 

  11. Hoelzer DF (1993) Therapy of the newly diagnosed adult with acute lymphoblastic leukemia. Hematol Oncol Clin North Am 7:139–160

    PubMed  Google Scholar 

  12. Hoelzer D, Thiel E, Loffler H et al (1984) Intensified therapy in acute lymphoblastic and acute undifferentiated leukemia in adults. Blood 64:38–47

    PubMed  Google Scholar 

  13. Hoelzer D, Thiel E, Loffler H et al (1988) Prognostic factors in a multicenter study for treatment of acute lymphoblastic leukemia in adults. Blood 71:123–131

    PubMed  Google Scholar 

  14. Hoelzer D, Thiel E, Ludwig WD, Loffler H, Buchner T, Freund M, Heil G, Hiddemann W, Maschmeyer G, Volkers B, Aydemir Ü (1992) The German trials for treatment of acute lymphoblastic leukemia in adults. Leukemia 6 S2:175–176

    PubMed  Google Scholar 

  15. Hussein KK, Dahlberg S, Head D, Waddell CC, Dabich L, Weick JK, Morrison F, Saiki JH, Metz E, Rivkin SE, Grever MR, Boldt D (1989) Treatment of acute lymphoblastic leu kemia in adults with intensive induction consolidation and maintenance chemotherapy. Blood 73:57–63

    PubMed  Google Scholar 

  16. Jacobs DA, Gale RP (1984) Recent advances in the biology and treatment of acute lymphoblastic leukemia in adults. N Engl J Med 311:1219–1231

    PubMed  Google Scholar 

  17. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

    Google Scholar 

  18. Kantarjian HM, Walters RS, Keating MJ, Smith TL, O'Brian S, Estey EH, Huh Yo, Spinolo J, Dicke K, Barlogie B, McCredie KB, Freireich EJ (1990) Results of the vincristine, doxorubicin, and dexamethasone regimen in adults with standard- and high-risk acute lymphoblastic leukemia. J Clin Oncol 8:994–1004

    PubMed  Google Scholar 

  19. Kantarjian HM, Estey EH, O'Brian S, Anaissie E, Beran M, Pierce S, Robertson L, Keating MJ (1992) Intensive chemotherapy with mitoxantrone and high-dose cytosine arabinoside followed by granulocyte macrophage colony-stimulating factor in the treatment of patients with acute lymphocytic leukemia. Blood 79:876–881

    PubMed  Google Scholar 

  20. Lister TA, Whitehouse MA, Beard MEJ, Brearley RL, Wrigley PM, Oliver RT, Freeman JE, Woodruff KK, Malpas JS, Paxton AM, Crother D (1978) Combination chemotherapy for acute lymphoblastic leukemia in adults. Br Med J 1:199–203

    PubMed  Google Scholar 

  21. Marcus RE, Catovsky D, Johnson SA, Gregory WM, Talavera JG, Goldman JM, Galton DA (1986) Adult acute lymphoblastic leukemia: a study of prognostic features and response to treatment over a ten-year period. Br J Cancer 53:175–180

    PubMed  Google Scholar 

  22. Maurer J, Janssen JW, Thiel E, Van Denderen J, Ludwig WD, Aydemir Ü, Heinze B, Fonatsch C, Harbott J, Reiter A, Riehm H, Hoelzer D, Bartram CR (1991) Detection of chimeric BCR-ABL genes in acute lymphoblastic leukemia by polymerase chain reaction. Lancet 337:1055–1058

    PubMed  Google Scholar 

  23. Pees HW, Radtke H, Schwamborn J, Graf N (1992) The BFM protocol for HIV-negative Burkitt's lymphomas and L3 ALL in adult patients: a high chance for cure. Ann Hematol 65:201–205

    PubMed  Google Scholar 

  24. Preti A, O'Brian S, Robertson S, Smith T, Estey E, Beran M, Pierce S, Keating M, Kantarjian H (1993) Acute lymphoblastic leukemia (ALL) in the elderly: characteristics and outcome with vincristine-adriamycin-dexamethasone (VAD) regimen. Blood 82:57a (abstract)

    Google Scholar 

  25. Secker-Walker LM, Craig JM, Hawkins JM, Hoffbrand AV (1991) Philadelphia-positive acute lymphoblastic leukemia in adults: age distribution, BCR breakpoint and prognostic significance. Leukemia 5:196–199

    PubMed  Google Scholar 

  26. Schauer P, Arlin ZA, Mertelsmann R, Cirrincione C, Friedman A, Gee TS, Dowling M, Kempin S, Straus DJ, Koziner B, McKenzie S, Thaler HT, Dufour P, Little C, Dellaquila C, Ellis S, Clarkson B (1983) Treatment of acute lymphoblastic leukemia in adults: results of the L-10 and L-10M protocols. J Clin Oncol 1:462–470

    PubMed  Google Scholar 

  27. Scherrer R, Geissler K, Kyrle PA, Gisslinger H, Jäger U, Bettelheim P, Laczika K, Locker G, Scholten C, Sillaber C, Schwarzinger I, Thalhammer F, Lechner K (1993) Granulocyte colony-stimulating factor (G-CSF) as an adjunct to induction chemotherapy of adult acute lymphoblastic leukemia (ALL). Ann Hematol 66:283–289

    PubMed  Google Scholar 

  28. Sobol RE, Mick R, Royston I, Davey FR, Ellison RR, Newman R, Cuttner J, Griffin JD, Collins H, Nelson DA, Bloomfield CD (1987) Clinical importance of myeloid antigen expression in adult acute lymphoblastic leukemia. N Engl J Med 316:1111–1117

    PubMed  Google Scholar 

  29. Taylor PR, Reid MM, Bown N, Hamilton PJ, Proctor SJ (1992) Acute lymphoblastic leukemia in patients aged 60 years and over: a population-based study of incidence and outcome. Blood 80:1813–1817

    PubMed  Google Scholar 

  30. Whitecar JP, Bodey GP, Freireich EJ (1972) Cyclophosphamide, vincristine, cytosine arabinoside and prednisone (COAP) combination chemotherapy for acute leukemia in adults. Cancer Chemother Rep 56:543–554

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine III, University of Ulm, P.O. Box 3880, D-89081, Ulm, Germany

    E. Späth-Schwalbe, G. Heil & H. Heimpel

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  1. E. Späth-Schwalbe
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  2. G. Heil
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Späth-Schwalbe, E., Heil, G. & Heimpel, H. Acute lymphoblastic leukemia in patients over 59 years of age. Ann Hematol 69, 291–296 (1994). https://doi.org/10.1007/BF01696557

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  • DOI: https://doi.org/10.1007/BF01696557

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