Older Adults With

A review of the annual age-specific leukemia incidence in the United States underscores the observation that ALL is relatively uncommon in the middle adult years, but increases rapidly in incidence over the age of 60. These patients have only rarely been included in clinical trials, and as yet, there are no optimal treatment programs available.

In a recent report from the northern counties of England, approximately one-third of ALL cases in adults occurred in patients older than 60 years.122 Various treatment approaches have been taken in this older group of patients, but the outcomes are uniformly poor (Table 13.4). Investigators at the MD

Anderson Hospital have reported on 52 patients treated with infusional vincristine, adriamycin, and dexamethasone (VAD). This regimen produced a high CR rate with relatively low toxicity in older patients.6 In the most recent CALGB trials, a CR rate of 65% was observed in older patients (60-80 years old, with a median age of 65).5'44 Nevertheless, the 3-year survival in all three of these reports remains poor. The low tolerance of elderly patients for intensive chemotherapy remains one of the obstacles to increasing the overall cure rate in adults.123 It is now estimated that as many as 40-50% of patients older than 60 years are Ph+; therefore, the focus on novel nonmyelosuppressive molecular targeted treatment strategies, as discussed above, is particularly needed for this very high risk group of patients. As previously discussed, the promising early results of combination chemotherapy with imatinib in older patients with Ph+ ALL are an example of the potential to significantly improve CR rates and, perhaps, OS in elderly patients with ALL.

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