GULHANE MEDICAL JOURNAL 2004 , Vol 46 , Issue 4
Our Treatment Results in Patients with ANNL Over 60 Years Old
Dr. Oral NEVRUZ1, Dr. Cengiz BEYAN1, Dr. Şefik GÜRAN2, Dr. Ahmet IFRAN1, Dr. Yusuf TUNCA3, Dr. Kürşat KAPTAN1, Dr. Türker ÇETİN1, Dr. Ali Uğur URAL1
1GATA Hematoloji Bilim Dalı
2GATA Tıbbi Biyoloji Bilim Dalı
3GATA Tıbbi Genetik Bilim Dalı
Acute nonlymphocytic leukemias are a subgrup of leukemias whose incidence is increasing and prognosis getting worse with advancing age. In this study, we present 29 cases over 60 years-old who have a diagnosis and treatment of ANLL between January 1999 and March 2004. Of these patients, 21 were de novo ANLL and 8 were secondary cases. Secondary ANLL cases transformed from CML in 3 patients, MDS in 4 patients and PV in one patient. Mean age of de novo cases was 68.4 years(60-80). 16 patients were men and 13 were women. According to FAB classification, 10 cases were M2, 6 were M4, 2 were M1 and M0, M3 and M5 were 1 each. At the time of diagnosis, mean Hb was 8.06 gr/dl(7.1-11.4), WBC was 38,900 mm3(800-195,000), platelet was 60,500/mm3(8,000-203,000). Fifteen patients have secondary diseases such as DM, hypertension, congestive heart failure and ischemic heart disease. After confirming diagnosis with peripheral blood film, bone marrow aspiration and immunephenotyping, standard induction regimen with idarubicin + cytozine arabinoside or mitoxanthron+ cytosin arabiosid was started. ANLL-M3 case had t(15-17) anomaly and ATRA was given to this patient. Febrile neutropenia developed in all cases. Eighteen patients died during febrile neutropenia period. Three patients died of intracerebral hemorrage, heart failure and leucocytosis. One of seven patients who achieved remission was a patient who transformed from MDS, and 1 patient was the only M3 subtype patient. Four of patients who achieved remission relapsed in first 3 months and intermediate or high dose ARA-C containing re-induction regimens were given to these patients. Two of these patients died during this period and remission was re-achieved in the other two. Regular follow-up's are still going on for 3 patients in 1st remission and for 2 patients in 2nd remission. Keywords : Acute Nonlenfositer Leukemia, Elderly Patient