Philadelphia chromosome-positive chronic myeloid leukemia in the elderly:: presenting features, natural history and survival

BACKGROUND: Among patients with chronic myeloid leukaemia (CML) old people represent a minority whose disease characteristics are not well known. The aim of the study was to analyze the presenting features, the evolutive course, and the survival of older persons with Ph-positive CML, PATIENTS AND METHODS: Forty-four individuals > 65 years diagnosed with Ph-positive CML in a single centre were compared with 292 younger patients. RESULTS: Comparison of the presenting features of chronic phase Ph-positive CML patients yielded the following significant differences: predominance of female sex (15 males/29 females versus 155/137; p = 0.02), higher proportion of patients with anaemic syndrome (12% versus 2%; p = 0.001), lower frequency of splenomegaly (41% versus 68%; p = 0.001), and higher serum levels of uric acid (p = 0.0006) in the older group. Although the latter patients survived significantly less (median survival 36.6 months, 95% CI: 27-46.2, versus 57.6 months, 95%: 51.2-64.1; p = 0.004), 9 of the 33 deaths registered in this group (27%) occurred in the chronic phase of CML, versus 15 (9%) of the 166 deaths in the younger group (p = 0.003). When chronic phase deaths were excluded and leukaemia-related deaths only considered (i.e,, those occurring in the BC or the accelerated phase of CML), old patients still had a shorter survival but the difference was no longer significant. CONCLUSIONS: Ph-positive CML features are essentially the same in older and young individuals, since most of the differences observed are attributable rather to the patients' advanced age than to the leukaemia itself.