Age Matters When Treating Leukemia

Chronic lymphocytic leukemia responds to different medications differently at different ages

(RxWiki News) Unless a child is involved, age usually isn’t considered when prescribing cancer treatment. A new study finds that might need to be changed for certain leukemia patients.

People over the age of 70 don’t respond as well to the most commonly used chronic lymphocytic leukemia (CLL) treatments. A recent study finds older CLL patients do better with chlorambucil (marketed as Leukeran) than with fludarabine (Fludara). And CLL patients of all ages respond well to a combination of rituximab (Rituxan) and fludarabine.

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The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) study was led by Assistant Professor of Hematology, Jennifer Woyach, MD.

“Our analysis shows that optimal therapy for younger and older patients with chronic lymphocytic leukemia is likely to be different, at least when using current treatments,” Dr. Woyach said in a statement.

About 15,000 Americans learn they have CLL every year. Most people are diagnosed over the age of 65, with the average age at diagnosis being 72. However, most clinical trial participants are younger – in their early 60s, according to the authors.

Principal investigator, John Byrd, MD, OSCUCC professor of medicine and CLL specialist, worked with Dr. Woyach and colleagues in reviewing information about 663 patients enrolled in four clinical trials evaluating CLL front-line (initial) therapies. The researchers compared the outcomes by age to find the best way to treat the disease in older adults.

Here’s what the trials uncovered:

  • Fludarabine helped patients under the age of 70 live longer overall (overall survival), with longer periods of stable disease (progression-free survival – PFS).
  • People over the age of 70 lived longest with chlorambucil
  • For both younger and older patients, rituximab combined with fludarabine was best in extending both overall survival and PFS.
  • Alemtuzumab consolidation therapy following chemotherapy didn't improve either overall or progression-free survival in older or younger patients.

The authors conclude, “These data support the use of chlorambucil as an acceptable treatment for many older patients with CLL and suggest rituximab is beneficial regardless of age.”

The authors also propose that these findings be considered when designing clinical trials for older adults.

This study was published December 10 in the Journal of Clinical Oncology. Funding for this research came from the National Institutes of Health/National Cancer Institute grants, the Leukemia and Lymphoma Society, the Harry Mangurian Foundation and the D. Warren Brown Family Foundation.

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Review Date: 
January 14, 2013