1. ¹Department of Hematology, Hôpital de Jolimont, Haine-Saint-Paul, Belgium
2. ²Department of Hematology, CHU Paris-Necker, Paris, France
3. ³Department of Hematology, Hôpital E Herriot, Lyon, France
4. ⁴Department of Hematology, Hôpital A Mignot, Versailles, France
5. ⁵Department of Hematology, Hôpital Purpan, Toulouse, France
6. ⁶Department of Hematology, Hôpital Saint-Louis, Paris, France
7. ⁷Department of Hematology, Hôpital Michallon, Grenoble, France
8. ⁸Department of Hematology, Hôtel-Dieu, Paris, France
9. ⁹Department of Hematology, CHU Nancy Brabois, Nancy, France
10. ¹⁰Department of Hematology, Hôtel-Dieu, Nantes, France
11. ¹¹Department of Hematology, Hôpital Dupuytren, Limoges, France
12. ¹²Department of Hematology, CHU de Caen, Caen, France
13. ¹³Department of Hematology, Hôpital Bretonneau, Tours, France
14. ¹⁴Department of Hematology, Hôpital Saint-Antoine, Paris, France
15. ¹⁵Department of Hematology, Institut Paoli Calmettes, Marseille, France
16. ¹⁶Department of Hematology, Hôpital L Pasteur, Colmar, France
17. ¹⁷Department of Hematology, CH d'Aix, Aix-en-Provence, France
18. ¹⁸Department of Hematology, Hôpital C Huriez, Lille, France
19. ¹⁹Department of Hematology, Hôpital de Hautepierre, Strasbourg, France
20. ²⁰Department of Hematology, Cliniques Universitaires de Godinne, Yvoir, Belgium
21. ²¹Department of Hematology, CHU du Haut-Levêque, Bordeaux, France
22. ²²Department of Hematology, Novartis Pharma, Rueil Malmaison, France

Correspondence: Professor A Delannoy, Department of Hematology, Hôpital de Jolimont-Lobbes, Rue Ferrer, 159, B-7100 Haine-Saint-Paul, Belgium. E-mail: a.delannoy@skynet.be

Received 15 April 2006; Revised 11 June 2006; Accepted 14 June 2006; Published online 13 July 2006.

Abstract

Acute lymphoblastic leukemia (ALL) in the elderly is characterized by its ominous prognosis. On the other hand, imatinib has demonstrated remarkable, although transient, activity in relapsed and refractory Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL), which prompted us to assess the use of imatinib in previously untreated elderly patients. ALL patients aged 55 years or older were given steroids during 1 week. Ph+ve cases were then offered a chemotherapy-based induction followed by a consolidation phase with imatinib and steroids during 2 months. Patients in complete response (CR) after consolidation were given 10 maintenance blocks of alternating chemotherapy, including two additional 2-month blocks of imatinib. Thirty patients were included in this study and are compared with 21 historical controls. Out of 29 assessable patients, 21 (72%, confidence interval (CI): 53–87%) were in CR after induction chemotherapy vs 6/21 (29%, CI: 11–52%) in controls (P=0.003). Five additional CRs were obtained after salvage with imatinib and four after salvage with additional chemotherapy in the control group. Overall survival (OS) is 66% at 1 year vs 43% in the control group (P=0.005). The 1-year relapse-free survival is 58 vs 11% (P=0.0003). The use of imatinib in elderly patients with Ph+ ALL is very likely to improve outcome, including OS.