[Acute lymphoblastic leukemia in elderly: prognosis and treatment]

Over 60 years old, acute lymphoblastic leukemia (ALL) represents between 16 and 31% of all adult cases. Pre-B and common ALL are frequent, while T-cell lineage ALL is under-represented in elderly populations as compared with younger adults. The frequency of Philadelphia chromosome seems also to increase with age and adversely influences complete remission (CR) and survival rates. Poor performance status, co-morbidity factors and early mortality during intensive induction chemotherapy are the main reasons for poor outcome. Few reports on effectiveness and toxicity of therapeutic regimens involving exclusively elderly patients with ALL have been published and only some of them were prospective studies. Age-adapted approaches with less aggressive chemotherapy have been applied. The overall response ranged from 12 to 85%. Toxic death during induction chemotherapy was observed in 7 to 42% of the patients. Among the patients who received a curative approach, the median overall survival duration ranged from 3 to 14 months, while it ranged from 1 to 14 months for those treated palliatively. New therapeutic approaches are warranted to improve the outcome in this age group of ALL patients.