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Treatment of Acute Lymphoblastic Leukemia in the Elderly: An Evaluation of Interferon Alpha Given as a Single Agent After Complete Remission

Although interferon (IFN) has been used in elderly patients with acute lymphoblastic leukemia (ALL), the benefits from IFN therapy have not been properly assessed, especially as it was given combined with other cytotoxic drugs, which obscured the role of IFN if any. In 1997, we started a study aimed...

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Published in:Leukemia & lymphoma 2002, Vol.43 (1), p.75-81
Main Authors: Delannoy, A., Cazin, B., Thomas, X., Bouabdallah, R., Boiron, J.M., Huguet, F., Straetmans, N., Zérazhi, H., Vernant, J.P., Dombret, H., Bilhou-Nabera, C., Charrin, C., Boucheix, C., Sebban, C., Lhéritier, V., Fière, D.
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container_title Leukemia & lymphoma
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creator Delannoy, A.
Cazin, B.
Thomas, X.
Bouabdallah, R.
Boiron, J.M.
Huguet, F.
Straetmans, N.
Zérazhi, H.
Vernant, J.P.
Dombret, H.
Bilhou-Nabera, C.
Charrin, C.
Boucheix, C.
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Lhéritier, V.
Fière, D.
description Although interferon (IFN) has been used in elderly patients with acute lymphoblastic leukemia (ALL), the benefits from IFN therapy have not been properly assessed, especially as it was given combined with other cytotoxic drugs, which obscured the role of IFN if any. In 1997, we started a study aimed at improving our previous results in elderly patients with ALL and at assessing the therapeutic role of IFN in this disease. Fifty-eight patients with ALL, aged 55-81 years (median: 64.9 years), were randomly allocated to treatment with vindesine or vincristine during induction. After a first consolidation course, IFN was administered as a single agent for three months together with cranial radiotherapy. Chemotherapy was then resumed with a second consolidation course and maintenance. A complete remission (CR) was obtained in 58% of patients (CI: 45-71%), significantly less than in our previous study which included IFN combined with chemotherapy during maintenance (CR: 85%, CI:70-94%, p =0.007 ). Overall survival (median: 289 vs 434 days in the previous study, p =0.01 ) and disease-free survival (median: 146 vs 427 days, p =0.009 ) were also inferior in the present study. In particular, the pattern of relapses over time suggested that the 3 month IFN treatment phase with no additional chemotherapy might have contributed to the comparatively poor outcome of this cohort. In addition, vindesine given during induction did not prove less neurotoxic than vincristine, did not improve the CR rate, and had no impact on survival. In conclusion, although similar to published studies in elderly patients with ALL, this study is inferior to our previous one. INF, given as a single drug, has a modest role if any in the treatment of older persons with ALL.
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In 1997, we started a study aimed at improving our previous results in elderly patients with ALL and at assessing the therapeutic role of IFN in this disease. Fifty-eight patients with ALL, aged 55-81 years (median: 64.9 years), were randomly allocated to treatment with vindesine or vincristine during induction. After a first consolidation course, IFN was administered as a single agent for three months together with cranial radiotherapy. Chemotherapy was then resumed with a second consolidation course and maintenance. A complete remission (CR) was obtained in 58% of patients (CI: 45-71%), significantly less than in our previous study which included IFN combined with chemotherapy during maintenance (CR: 85%, CI:70-94%, p =0.007 ). Overall survival (median: 289 vs 434 days in the previous study, p =0.01 ) and disease-free survival (median: 146 vs 427 days, p =0.009 ) were also inferior in the present study. 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subjects Acute Lymphoblastic Leukemia
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Antineoplastic Combined Chemotherapy Protocols - toxicity
Brain Neoplasms - prevention & control
Brain Neoplasms - radiotherapy
Elderly
Female
Humans
Interferon
Interferon-alpha - administration & dosage
Interferon-alpha - therapeutic use
Male
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality
Precursor Cell Lymphoblastic Leukemia-Lymphoma - radiotherapy
Random Allocation
Recurrence
Remission Induction - methods
Survival Analysis
Treatment Outcome
Vincristine - administration & dosage
Vincristine - toxicity
Vindesine
Vindesine - administration & dosage
Vindesine - toxicity
title Treatment of Acute Lymphoblastic Leukemia in the Elderly: An Evaluation of Interferon Alpha Given as a Single Agent After Complete Remission
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