Acute lymphocytic leukaemia in the elderly: Characteristics and outcome with the vincristine-adriamycin-dexamethasone (VAD) regimen

To analyse the pretreatment characteristics, response to therapy, and overall prognosis of elderly patients with acute lymphocytic leukaemia (W), 268 consecutive adults with newly-diagnosed ALL who received the vincristine-adriamycin-dexamethasone (VAD) regimens were reviewed. Pretreatment characteristics, response to VAD therapy, and overall outcome were analysed in patients 60 years or older, and compared to younger patients. Fifty-two patients (19%) were 60 years or older. Compared with younger patients, elderly patients with ALL had a significantly worse performance status at presentation (P < 0.001); higher incidences of FAB L2 morphology (P = 0 .03). thrombocytopenia (P < 0.01), hypoalbuminaemia (P < 0.001) and renal dysfunction (P = 0.03); and trends for worse anaemia (P = 0.06) and a higher rate of myeloid markers positivity (P = 0.06). With VAD induction therapy, elderly patients had a lower CR rate than younger patients following two induction courses (CR rate 58% v 82%; P < 0.01), and overall (CR rates 65% v 90%; P < 0.01). The response rate to VAD chemotherapy, however, appeared superior to the 30-35% CR rates reported from other series in elderly ALL patients. The lower CR rate was due to both higher induction mortality (P = 0.02) and more resistant disease (P < 0.01). The longterm CR rate was 20% in elderly patients achieving CR, but the overall survival was poor (< 10% at 3 years). There were strong associations between older age and other poor prognostic features. However, multivariate analyses identified older age to be an independent poor prognostic factor for response to chemotherapy. In summary, elderly patients with ALL have an appreciable CR rate with the VAD regimens. Patients achieving CR may have durable remissions. The myelosuppression-associated mortality in both remission induction and maintenance may be reduced with the addition of growth factors in both treatment phases, and by using standard maintenance therapy without consolidation-intensification phases.