ALL in the Elderly

The proportion of ALL in patients older than age 60 years constitutes between 16% and 31% of all adult leukemias. Treatment of adults largely has followed the conventional chemotherapeutic regimes used in childhood ALL. However, the intensification regimens common in childhood are not suitable for this population because of their associated toxicities in older patients. The adverse prognostic factor, the Ph+, occurs in 15% to 30% of adults and thus is more common in the over 60 age group.21 Based on the experience achieved in CML, the use of imatinib, a potent inhibitor of the Ph+-associated BCR-ABL tyrosine kinase, is becoming a common practice for these older adults. Results show that the combination of imatinib with conventional chemotherapy has improved remission rates compared with the use of conventional chemotherapy alone, although the effect on long-term disease-free survival (DFS) is unclear. With other tyrosine kinase inhibitors, dasatinib and nilotinib, resistance can be overcome, but the remission is not long lasting. Improving the outcomes of these elderly patients with ALL continues to be a challenge.

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