Acute lymphoblastic leukemia in patients aged 60 years and over: a population-based study of incidence and outcome

Data on all patients aged 60 or older in whom a diagnosis of acute lymphoblastic leukemia (ALL) was made in the Northern Health Region of the United Kingdom, over a period of 8 1/2 years, were studied to determine the incidence and range of biological subtypes, and the outcome of a variety of therapeutic approaches. Forty-nine cases were diagnosed (31% of all adult ALL), giving an incidence of 0.9 per 100,000 age-specific population (ASP). Immunophenotyping was performed in 41 patients. Eighteen had common, two T-ALL, 10 null, and 7 B-ALL. Four were biphenotypic with both lymphoid and myeloid markers. One patient refused treatment and four were considered too frail for chemotherapy. Twenty-two were treated palliatively. Aggressive "curative" treatment was planned for 22, but three died before it started. The actuarial survival for the whole group was 4%. The median survival of the palliatively treated group was 1 month, compared with 3 months for those given aggressive treatment. Only two patients (aged 74 and 67) survived more than 2 years in complete remission (CR), both having been treated aggressively. We conclude that the prognosis for those over 60 years of age is extremely poor, but that for a small number of patients a useful prolongation of good quality life may be achieved. Age should not, by itself, be a bar to treatment intended to induce remission. Patients and their relatives should be made aware of the overall poor prognosis and advised of the therapeutic goals when decisions regarding management are being made.