Background. Understanding the causes of failure in older patients with ALL may help improve treatment strategies for this age group.

Study Aims. To define the causes of death in older (age ≥60 years) patients with ALL during induction and consolidation-maintenance with the dose intensive Hyper-CVAD regimen, and compare their outcome to those of older patients treated previously with less intensive regimens, and to those of younger patients treated with Hyper-CVAD.

Study Groups. 122 older patients treated with Hyper-CVAD were compared with 34 older patients treated with less intensive regimens, and 409 younger patients treated with Hyper-CVAD.

Results. The outcome in older patients on Hyper-CVAD, older patients on other regimens, and younger patients on Hyper-CVAD are shown in the Table.

Conclusion. Intensifying the chemotherapy in older patients with ALL reduced the incidence of leukemia resistance but increased the incidence of death in CR from myelosuppression-associated infections. The overall benefit: risk was favorable. Identifying novel low-intensity agents/regimens for older patients with ALL may improve the results.

ParameterOlder; Hyper CVADOlder; OtherYounger; Hyper CVADP value
Most deaths during induction and in CR were related to infections 
Number 122 34 409  
% CR 84 59 92 <0.001 
% Induction mortality 10 12 2 NS for older 
% Resistance 5 27 2 <0.001 
% Death in CR 34 15 7 <0.001 
% Relapse 40 80 48 0.004 
% 5-year survival 20 9 48 <0.001 
ParameterOlder; Hyper CVADOlder; OtherYounger; Hyper CVADP value
Most deaths during induction and in CR were related to infections 
Number 122 34 409  
% CR 84 59 92 <0.001 
% Induction mortality 10 12 2 NS for older 
% Resistance 5 27 2 <0.001 
% Death in CR 34 15 7 <0.001 
% Relapse 40 80 48 0.004 
% 5-year survival 20 9 48 <0.001 
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Topics:
acute lymphocytic leukemia, hypercvad protocol, older adult, infections, chemotherapy regimen, leukemia, myelosuppression

Disclosures: No relevant conflicts of interest to declare.

Author notes

Corresponding author

2008, The American Society of Hematology
2008
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