６０歳以上の高齢者急性リンパ性白血病の臨床的検討

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  • Analysis of Elderly Patients, Aged 60 Years Old or over, with Acute Lymphoblastic Leukemia.
  • 60サイ イジョウ ノ コウレイシャ キュウセイ リンパセイ ハッケツビョウ ノ リンショウテキ ケントウ

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In order to obtain the realistic background information on clinical features, and the present status of treatment and outcome in elderly patietnts with acute lymphoblastic leukemia (ALL), we carried out random survey of patients with ALL aged 60 or over who had been admitted to 13 general hospitals in the Nagoya region from January 1990 through December 1995.<br>Among the 20 cases collected, ages ranged from 60 to 88 (median age 68), and the male to female ratio was 11: 9. Nineteen cases were L2 subtype in FAB classification. Among 17 patients, 13 had B cell series surface phenotypes (76%), 2 had T cell series (12%), one had stem cell type (6%) and one had an undetermined phenotype (6%). Ph chromosomes were detected in 4 cases among 15 analized (27%), whereas 5 were found to have no chromosomal abnormality. Half of the patients had some concurrent disease at diagnosis, including two with treatment-limiting complicatioms.<br>Common induction regimens were the combination of adriamycin (ADM)+vincristine (VCR)+cyclophosphamide (CPM)+mitoxdn trone+L-asparaginase [4 patients], ADM+VCR+PSL [4 patients], VCR+PSL [4 patients] and others [8 patients]. The overall remission rate was 55.0% (11/20) without any significant difference according to age. The median survival time (MST) for all cases was 205 days (1-year survivial rate: 17.9%, 2-year survival rate: 10.8%). There was no significant differrence in survival times among patients with the Ph chromosome, those with other chromosomal abnormalities and those without them. All the patients aged 75 or over were treated with attenuated induction therapy, and they had a shorter survivial than those aged less than 75, but with no statistical siginificance [MST; 121 days versus 276 days, p=0.307 (generalized Wilcoxon test)].

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