Best leukemia therapy may depend on patient age

Although age usually is not factored into treatment choices for persons with chronic lymphocytic leukemia (CLL), a new study indicates that older patients may not respond as well as others to conventional therapies.

“Our analysis shows that optimal therapy for younger and older patients with [CLL] is likely to be different, at least when using current treatments,” affirmed Jennifer A. Woyach, MD, first author of the study, in a statement issued by the Ohio State University Wexner Medical Center in Columbus, Ohio. Woyach is an assistant professor of hematology at The Ohio State University Comprehensive Cancer Center–Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, also in Columbus.

Woyach and colleagues noted in their report for Journal of Clinical Oncology that although CLL is a disease of the elderly, few clinical trials include a significant number of older patients and outcomes after specific therapies can differ depending on the patient's age. According to information from Ohio State, CLL most often occurs in persons older than age 65 years, with the average age of diagnosis being 72 years, yet most participants in clinical trials for CLL treatments are in their early 60s.

To determine whether the efficacy of CLL treatment regimens varied by patient age, the investigative team examined persons enrolled in successive first-line trials sponsored by the Cancer and Leukemia Group B clinical cooperative group. The researchers focused on ideal chemotherapy choice and benefit of immunotherapy in addition to chemotherapy in older patients. Regimens included chlorambucil, fludarabine, fludarabine plus rituximab (FR), fludarabine with consolidation alemtuzumab, and FR with consolidation alemtuzumab.

The researchers learned the following after evaluating 663 patients:

  • Among patients younger than age 70 years, both progression-free survival and overall survival were improved with fludarabine over chlorambucil. This was not seen in older adults.
  • Chlorambucil tended to produce higher overall survival in patients older than age 70 years.
  • FR improved outcomes more than did fludarabine, irrespective of patient age.
  • Alemtuzumab consolidation did not provide benefit over similar regimens without alemtuzumab, irrespective of age.

Woyach and coauthors concluded that their data support the use of chlorambucil as an acceptable treatment for many persons with CLL who are older than age 70 years. In addition, the data suggest that rituximab is beneficial regardless of age.

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