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Prognostic factors in elderly acute lymphoblastic leukaemia
O Legrand1, J P Marie, Z Marjanovic
1Service d'Hématologie Clinique, Hôpital Hôtel-Dieu, Paris, France.
British Journal of Haematology
|June 1, 1997
Summary
Elderly patients with acute lymphoblastic leukemia (ALL) have poor outcomes, with less than half achieving remission. Performance status and age significantly impact survival, suggesting tailored treatment approaches for older ALL patients.
Area of Science:
- Hematology
- Geriatric Oncology
- Clinical Trials
Background:
- Acute lymphoblastic leukemia (ALL) disproportionately affects elderly patients.
- Published data on elderly ALL often excludes a significant portion of patients, leading to selection bias.
- Outcomes for elderly ALL patients are generally poorer compared to younger populations.
Purpose of the Study:
- To evaluate the outcomes of unselected elderly patients with acute lymphoblastic leukemia (ALL).
- To identify factors influencing complete remission (CR) and survival in this population.
- To assess the impact of age and performance status on treatment response and mortality.
Main Methods:
- Retrospective analysis of 46 unselected acute lymphoblastic leukemia (ALL) patients aged 60 years or older.
- Inclusion criteria focused on age and diagnosis, not trial eligibility.
- Multivariate analysis was used to determine prognostic factors.
Main Results:
- Only 43% of elderly ALL patients achieved complete remission (CR).
- Median survival was 10 months, with a 5-year overall survival of 7.6%.
- WHO performance status and peripheral blast counts at day 7 significantly influenced CR and survival.
Conclusions:
- Elderly ALL patients exhibit poor survival rates and are often underrepresented in clinical trials.
- Age > 70 and WHO performance status >= 2 are associated with significantly lower CR rates and higher induction mortality.
- Treatment protocols for ALL should be individualized for elderly patients based on performance status and age, with less intensive options for those with poorer prognostic indicators.