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Chronic myeloid leukemia in the elderly: long-term results from randomized trials with interferon α

Abstract

Chronic myeloid leukemia (CML) in older patients has not been studied well. To assess the long-term outcome of older patients with Philadelphia- and/or BCR-ABL-positive CML, 199 patients aged 60 years representing 23% of 856 patients enrolled in the German randomized CML-studies I (interferon α (IFN) vs hydroxyurea (HU) vs busulfan (BU) and II (IFN+HU vs HU alone) were analyzed after a median observation time of 7 years. In all, 45 patients were treated with Bu, 63 with HU, and 91 with IFN. The 5-year survival was 38% in patients 60 years and 47% in patients <60 years (P<0.001). Whereas 5-year survival in chemotherapy-treated older patients was inferior to that in younger patients (33 vs 46%, P=0.006 for HU and 29 vs 38%, P=0.042 for Bu), no significant survival difference could be verified in IFN-treated patients (46 vs 53%, P=0.077). Calculation of age-adjusted, relative survival confirmed these results. Adverse effects of IFN were similar in both age groups, but IFN dosage to achieve treatment goals was lower in older patients. We conclude that the course of CML is not different in the elderly. They require lower IFN doses, achieve the same hematologic and cytogenetic response rates and the same survival advantage at comparable toxicity.

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Acknowledgements

The study was supported by a grant from the German Ministry of Education and Research (BMBF), Competence network ‘Acute and chronic leukemias’–01 GI9980/6, by a grant of Hoffmann-La Roche to the Süddeutsche Hämoblastosegruppe (SHG) and by the Forschungsfonds der Fakultät für Klinische Medizin Mannheim der Universität Heidelberg. The assistance of Matthias Dumke, Christine Folz, Gabriele Lalla, Katja Adam, Katja Enghofer, Michael Schmidt, and Renate Eckel is gratefully acknowledged. Participating institutions were as follows: Aachen: Hämatologisch-Onkologische Praxis (U Essers, L Habets); Aalen: Kreiskrankenhaus, Innere Abteilung (JD Faulhaber); Aarau: Kantonsspital, Med. Klinik (K Giger, M Wernli); Aschaffenburg: Klinikum, Med. Klinik (W Fischbach, J Brücher); Augsburg: Zentralklinikum, II. Med. Klinik (G Schlimok); Bad Saarow: Humaine Klinikum, Klinik f. Innere Medizin (W Schultze); Basel: Kantonsspital, Hämatologie/Onkologie (A Gratwohl, A Tichelli); Bayreuth: Krankenhaus Hohe Warte, Med. Klinik (D Seybold) Berlin: Hämatologische Praxis (BR Suchy); Krankenhaus Moabit, II. Innere Abteilung (K-P Hellriegel); Krankenhaus Berlin-Neukölln, II. Innere Abteilung (AC Mayr, G Middelhoff, A Grüneisen); II. Kinderklinik Berlin-Buch (W Dörffel); Univ.-Klinikum Charlottenburg, Kinderklinik u. Poliklinik (G Henze); Hämatologisch-Onkologische Schwerpunktpraxis (I Blau); Onkol.-Hämatol. Schwerpunktpraxis (I Weißenfels); Bern: Inselspital/Universitätsspital (A Tobler); Böblingen: Kreiskrankenhaus, Innere Abteilung (U Pfeilsticker, J Öller); Bonn: Universitätspoliklinik (H Vetter, YD Ko); Bremen: Zentralkrankenhaus (H Rasche, CR Meier); Bremerhaven: St Joseph-Hospital, Med. Klinik (H-H Heidtmann, A Pott); Duisburg: St -Johannes-Hospital, Med. Klinik II (M Westerhausen, W Fett, C Aul); Emden: Hans-Susemihl-Krankenhaus Med. Klinik (F Lindemann); Erfurt: Hämatologische Praxis (J Weniger); Klinikum, Med. Klinik (K Wutke, D Küstner); Internistische Praxis (U Hauch); Erlangen: Med. Univ.-Klinik (D Strobel, G Pongratz); Eschweiler: St-Antonius-Hospital, Hämatologie/Onkologie (R Fuchs); Frankfurt/M.: Univ.-Klinik, Zentrum der Inneren Medizin (L Bergmann D: Hoelzer, B Waßmann); Onkologische Gemeinschaftspraxis (M Fischer, Th Klippstein, F Walther); Freiburg: Med. Univ.-Klinik (L Kanz, J Finke, M Tilmann); Fürth: II. Med. Klinik (J Fink); Füssen: Kreiskrankenhaus (H Kremer); Göppingen: Klinik am Eichert, Med. Klinik II (E Kurrle, T Schmeiser); Gießen: Medizinische Klinik V, Zentrum für Innere Medizin (H Pralle); Hagen: Katholisches Krankenhaus, Hämatologie/Onkologie (H Eimermacher); Hamburg: Universitätsklinik, Hamburg-Eppendorf (DK Hossfeld, U Dührsen); Hämatologisch-Onkologische Praxis (UR Kleeberg); Allgemeines Krankenhaus Barmbek (U Müllerleile); Allgemeines Krankenhaus Altona, II. Med. Abt. (K Mainzer, Dr Meyran); Allgem. Krankenhaus St Georg (R Kuse, C zur Verth); Internistische Praxis (A Mohr); Hannover: Pathologisches Institut und Institut f. Klinische Immunologie der MHH (A Georgii, T Buhr); Institut f. Klinische Immunologie der MHH (H Deicher, P von Wussow); Heidelberg: Med. Univ.-Klinik (D Tapalaga, U Räth); Herford: Kreiskrankenhaus, Med. Klinik II (U Schmitz-Huebner); Kaiserslautern: Westpfalz-Klinikum (H Kreiter); Karlsruhe: Städt. Klinikum, II. Med. Klinik (J Th. Fischer); Kempten: Klinikum Kempten-Oberallgäu, Innere Abteilung (V Hiemeyer); Kiel: Städt. Krankenhaus (H Löffler); Universitätsklinik (HD Bruhn); Köln: Universitätsklinik I. Med. Klinik (V Diehl, C Scheid); Praxisgemeinschaft (R Zankovich); Lebach: Caritas-Krankenhaus (D Hufnagl, S Kremers) Lemgo: Klinikum Lippe/Lemgo (H-P Lohrmann); Lindenfels: Luisenkrankenhaus (J Hesselmann); Ludwigshafen: St Marienkrankenhaus, Med. Klinik (HH Weiss, A Seifert); Lugano: Medicina Interna ed Ematologia FMH (E Beck); Lüneburg: Gemeinschaftspraxis (B Goldmann); Mannheim: Universitätsklinikum, III. Med. Klinik (R Hehlmann, U Berger, A Hochhaus, A Reiter, G Metzgeroth, O Maywald, W Queißer); München: Universitätsklinikum Großhadern (H-J Kolb, A Muth); Universitätsklinikum Innenstadt (B Emmerich, M Hallek); Krankenhaus München-Schwabing (C Nerl, W Kaboth); Städt. Krankenhaus München-Harlaching (R Hartenstein, N Brack); Klinikum r. d. Isar d. TU (J Rastetter, M Perker); Med. Poliklinik (N Zöllner, M Jahn); Krankenhaus München-Neuperlach, IV. Med. Abt. (M Garbrecht, HJ Schäfer); Hämatologische Praxis (A Wohlrab); Institut für Med. Informationsverarbeitung, Statistik und Biomathematik der LMU und Biometrisches Zentrum für Therapiestudien (K Überla, J Hasford, H Ansari, M Pfirrmann); Münster: Universitätsklinik, Kinderheilkunde (B Rath); Neuruppin: Ruppiner Klinikum, Med. Klinik B (H Eggebrecht, D Nürnberg); Nürnberg: VII Medizinische Klinik (W Brockhaus), V Medizinische Klinik (WM Gallmeier, C. Falge); Oberhausen: Gemeinschaftspraxis (A Brunöhler); Oldenburg: Städt. Kliniken, Innere Medizin (F del Valle); Penzberg: Städt. Krankenhaus (K Ranft); Ravensburg: St Elisabeth-Krankenhaus Med. Klinik (G Meuret, S Mende); Regensburg: Krankenhaus der Barmherzigen Brüder (W Wellens, J Weiß, M Schenk); Schwäbisch-Hall: Diakonie-Krankenhaus (HH Heißmeyer, T Geer); St Gallen: Kantonsspital, Onkologische Abteilung (T Cerny, L Schmid); Traunstein: Stadtkrankenhaus, Onkologische Abteilung (G Biedermann); Ulm: Universitätsklinik, Med. Klinik III (H Heimpel, M Griesshammer); Institut f. Humangenetik (TM Fliedner, B Heinze) Waldbröl: Kreiskrankenhaus, Med. Klinik (L Labedzki); Wiesbaden: Dr Horst-Schmidt-Kliniken GmbH (N Frickhofen, H-G Fuhr); Wilhelmshaven: St Willehad-Hospital (W Augener); Würzburg: Universitätsklinik, Med. Poliklinik (K Wilms, M Wilhelm, H Rückle-Lanz).

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Berger, U., Engelich, G., Maywald, O. et al. Chronic myeloid leukemia in the elderly: long-term results from randomized trials with interferon α. Leukemia 17, 1820–1826 (2003). https://doi.org/10.1038/sj.leu.2403042

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