노령층 급성백혈병의 치료성적

Abstract

Objectives: Approximately 40-60% of acute myelogenous leukemia(AML) and 30% of acute lymphoblastic leukemia(ALL) occur in patients over 60 years old. The elderly leukemic patients showed less complete remission rate and shorter survival, and there have not been universal agreements on the desirable anti leukemic therapy for the elderly patients with acute leukemia. We investigated the clinical characteristics and therapeutic outcomes of 22 patients aged 60 or over diagnosed as acute leukemia during the last 5 years. Methods: Between January 1988 and December 1992, 31 patients aged 60 or over among 174 patients with newly diagnosed acute leukemia, were entered into this study. Among 31 elderly patients, 22 patients underwent remission induction chemotherapy. Remission induction chemotherapy in patients with AML consisted of TAD chemotherapy and low dose cytarabine, and patients with ALL received VPD chemotherapy. Clinical characteristics and therapeutic outcomes of the patients were analyzed retrospectively by review of patiet's medical records. Results: 1) Among 174 patients with acute leukemia, 31 patients were aged 60 or over(17.8%), consisted of 27 AML and 4 ALL patients and male to female ratio was 1: 1.1 median age of them was 65 years. There were no differences in hemogram, bone mar- row findings and complications such as infection, bleeding at the time of initial diagnosis between elderly patients and younger patients. 2) Of 22 elderly patients with acute leukemia received remission induction chemotherapy, twelve patients(55%) achieved complete ramission, comparable to that of younger patients(61%). But median duration of disease free survival and overall survival were significantly shorter(143 days vs 549 days, p= 0.001 and 251 days vs 368 days, p=0.008 respectively) in elderly patients. Complete remission rate of 18 elderly patients with AML was 50%, comparable to that of 77 younger patients with AML(64%), but median duration of disease free survival was significantly shorter(144 days vs 625 days, p=0.014). 3) Complete remission was achieved in 6(60%) of 10 elderly patients with AML received TAD induction chemotherapy, comparable to that of younger patients with AML received TAD chemotherapy(62.7 %) and early death rate was also comparable(10% vs 9% ). There was a trend toward longer durations of disease free survival in younger patients compared to that of elderly patients(625 days vs 144 days). Of whom achieved complete remission, 3 elderly AML(50% ) underwent consolidation chemotherapy as postremission chemotherapy and 88% of younger patients with AML underwent consolidation chemotherapy. 4) Of the 8 elderly patients with AML received low dose cytarabine as induction chemotherapy, 3 patients achieved complete remission and median duration of disease free survival was 85 days, trends toward lower remission rate and shorter duration of disease-free survival compared to that of patients received TAD induction chemotherapy(37.5% vs 60%, 85 days vs 144 days, respectively), but early death rate was camparable(12% vs 10% ). 5) There were no differences in durations of neutropenia, thrombocytopenis, transfusion requirement, infection and bleeding of grade 3 of more between elderly and younger patients with AML during remission induction chemtherapy. Elderly AML patients received TAD chemotherapy needed more frequent platelet transfusion compared to elderly patients received low dose cytarabine as induction chemotherapy(60 units vs 38 unit, p=0,045). Conclusion: The complete remission rate of the elderly patients with acute leukemia after remission induction chemotherapy was comparable to that of the younger patients, and further evaluations about more intensive postremission chemotherapy and supportive cares involving the use of hematopoietic growth factors in the elderly may be warranted.