Treatment of elderly patients with acute lymphoblastic leukemia

Abstract

Outcome in elderly patients with acute lymphoblastic leukemia (ALL) is poor. Older age, biological status and the presence of concomitant diseases limit the possibility to apply intensive chemotherapy in this group of patients, and result in decreased chance to achieve and maintain complete remission. Patients with Philadelphia-negative ALL who are candidates for radical treatment should receive induction and consolidation therapy with reduced doses of cytostatics, followed by either maintenance or non-myeloablative allogeneic hematopoietic stem cell transplantation (RIC-alloHSCT). Those with Philadelphia-positive ALL should be treated with tyrosine kinase inhibitors alone or combined with reduced dose chemotherapy, followed by either maintenance or RIC-alloHSCT. The use of imatinib-containing protocols increases CR rates and prolongs survival. Progress in the treatment of elderly patients with ALL may depend on introduction of novel therapeutic agents with limited organ toxicity while maintained antileukemic activity.