Comparison of two regimens for the treatment of elderly patients with acute lymphoblastic leukaemia (ALL).
Acute lymphoblastic leukemia (ALL) represents a rare malignancy in the elderly and few authors have specifically focused on the treatment of ALL in this setting. We recently published the results of a prospective phase II study comprising an induction therapy with vincristine, Daunoxome and dexamethasone (VDXD) given to 15 patients aged 60 years. Here, we update the results after enrolling 17 patients, and we compare these with the results obtained in 17 elderly patients treated according to the GIMEMA ALL 0288 protocol. With the VDXD combination, elderly ALL had a higher CR rate (76.5%) than with the 0288 protocol (41%), and it was likely due to both lower induction mortality (17.5% vs. 35%) and a less resistant disease (6% vs. 24%). Infectious complications were more frequent with the VDXD combination whereas non-hematological side effects were comparable. Despite the similar DFS obtained with the two induction treatments, median EFS (3.9 months with 0288 vs. 12.8 with VDXD; p = 0.0486) and OS (4.5 vs. 21 months; p = 0.0239) were significantly higher with the VDXD regimen. In elderly ALL patients the administration of high-dose daunorubicin as a liposomal compound is feasible and seems able to improve CR rate, EFS and OS without increase in toxicity.
Offidani
Massimo
M
Clinica di Ematologia, Università Politechnica delle Marche, Azienda Ospedaliera Umberto I, Ancona, Italy. m.offidani@ao-umbertoprimo.marche.it
Corvatta
Laura
L
Malerba
Lara
L
Marconi
Monica
M
Catarini
Massimo
M
Centurioni
Riccardo
R
Leoni
Franco
F
Scortechini
Anna Rita
AR
Masia
Maria Cristiana
MC
Leoni
Pietro
P
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003630:Daunorubicin / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007239:Infections / Q000139:chemically induced; D008081:Liposomes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D012074:Remission Induction / Q000379:methods; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
D008081:Liposomes; D014750:Vincristine; D003907:Dexamethasone; D003630:Daunorubicin