| Acute leukemia (AL) is a biologically heterogenous disease characterized by a clonal acumualation of immature blood cells, which ultimately leads to bone marrow failure. Chemotherapy is the mainly therapy of most acute leukemia. The disease incidence of the acute leukemia in elderly is higher than the young people.But now no best suitable choice of treatment for the senile patients can lead to the best curative effect. And the senile patients also have the characters of bad prognosis, high case fatality rate and short life span.So how to elevate the curative effect, how to improve the patient,s quality of life and lengthen their life span are popular topic of nowadays.Objective This text aims at through retrospective analysis of 55 cases of acute leukemia in elderly to approach the characteristics, the influencing factors of curative effect and progmostic of the senile patients.At the same time 56cases of young people are selected randomly as the control group in order to find a valid treatment.Materials and methods The computer records conservancy system have been used to retrieve the cases information which have been selected and diagnosed as AL in January 2000-June 2006 of our hospital. Information recorded including: age, sex, previous medical illness, the blood routine, the morphology of the bone morrow and the peripheral blood, the chromosome of the leukemia cell, the diagnosis and grouping, the chemotherapeutic regimen and dose, the complication, the nadir of the blood routine, the effective power for the first course of treatment, the course of the disease and the death cause. Following up all the patients to get the message of the existing condition and to record the onset time, the terminatd time, the death time and the missing connection time. All patients are followed-up to june 2006.Results 1. General information: Acute leukemia in elderly accounted for 13.41% (101/753) of adult acute leukemia; acute myeloid leukemia in elderly accounted for 13.18% (78/592) of adult acute myeloid leukemia; acute lymphoblastic leukemia in elderly accounted for 14.29% (78/592) of adult acute lymphoblastic leukemia; In elderly patients with acute leukemia, AML: ALL=3.39: 1; 64 men and 37 women, Male: female =1.73:1; The median age is 65 years old; MDS invert acute leukemia accounted for 13.80% (14/101); Compared with young patients: the rate of M0, M4, M5 and MDS invert AL are higher, the rate of M3 is lower, the early mortality is higher, and the differences are notable. 2. Compared the general clinical features of the elderly and the young treatment group: 61.81% of the older group patients have previous medical illness; 54.55% have mal-prognosic chromosome; all of these percentage are higher than the young and the differences are notable. The two group have no obvious differences among blood routine, the proliferation of the bone marrow and the quantity of the blast cell of the bone marrow. 3. The average survival time for palliative treatment of the elderly are 102.31±68.69 days, obviously shorter than the chemotherapy group; the effective power of the MDS invert AL is 18.18%, obviously lower than the do no AL, but the mortality have no significant difference; CR rate, efficiency rate and mortality of standard-dose chemotherapy regimen group have no significant difference with the dose reduction group; but the incidence of infection is 68.97%, much higher than the dose reduction group; the effective power compared between AML and ALL have no significant difference. 4. Compared the treatment of the elderly and the young treatment group: The choice of the chemotherapeutic regimen is similar. In the old age group, low-dose treatment accounting for 47.27%;in the course of the treatment, the complication of the infection and organ damage accounting for 54.54% and 29.09% respectively; About 65.45% of the elderly patients are only received one course of treatment; the nadir of the blood routine and the units of the blood transfusion have no obvious differences; to compare the effect of the two overall group, the CR rate and the effective power of the elderly are accounting for 27.91% and 48.84% respectively; the mortality is 32.56%; the CR rate and the effective power of the M3 in elderly are accounting for 45.45% respectively; the mortality is 45.45%; after excluding the M3, the effective power compared between the elderly and the young have no significant difference. The average survival time are 395.94days (1.084years). Survival curve also demonstrated survival time of the young group are longer then the elderly. 5. Analysing the relation between all the selective factors and the curative effect of the acute leukemian in elderly. The result shows: the effective power of the patients with WBC≥50×109/L is 11.11%; the effective power of the patients with mal-prognosic chromosome is 20%; the effective power of the cases who have the complication of the organ damage is 25%, and the effective power of the control group is much higher. The results have statistically significant differences. 6. Analysis of death risk of the senileAL: the cases who have mal-prognosic chromosome,the risk of death is 2. 532 times more than the ones who have satis-prognosic chromosome, the cases who have the complication of organ damage, the risk of death is 5. 698 times more than the ones who do not have.Conclusion 1. In our hospital, AL in elderly accounted for 13.18% (101/753) of adult AL; AML in elderly accounted for 13.18% (78/592) of adult AML; the median age of onset is 65 years old; Male: female=1.73:1; AML:ALL=3.39:1; 54.46% of the definite patients receive chemotherapy. 2. Compared with middle-aged patients: the rate of M0, M4, M5 and MDS invert AL are higher, the rate of M3 is lower, the early mortality is higher. 3. Compared the elderly and the young treatment group: in the elderly, the appearance of previous medical illness, the proportion of mal-prognosic chromosome are obviously higher than the young;otherwise, The hemogram of the elderly patients has the characters of high white blood cell, low hemoglobin and platelet. Bone marrow hyperplasity mainly show obvious and utmost active. These aspects are similar with the young. 4. The average survival time for palliative treatment are obviously shorter than the chemotherapy group; the CR rate and the effective power of the MDS invert AL is obviously lower than the do no AL; For the standard-dose chemotherapy regimen group, the CR rate, efficiency rate and mortality have no significant difference with the dose reduction group; but the incidence of infection is higher than the dose reduction group; the effective power of AML and ALL have no significant difference. 5. The treatment of the elderly and the young treatment group: The choice of the chemotherapeutic regimen is similar. But in the old age group,the rate of low-dose treatment is higher; in the course of the treatment, the complication of the infection and organ damage are more common; the CR rate and the effective power are lower; the mortality is higher; the average survival time are shorter; the CR rate and the effective power of the M3 in elderly are much lower; the mortality is higher; after excluding the M3, the effective power of the two group have no significant difference. Most of the elderly patients are only given one course of treatment. 6. The elderly patients who have the characters of WBC≥50×109/L, mal-prognosic chromosome, the complication of the organ damage show the lower effective power and worse curative effect. 7. Analysis of death risk of the senileAL: the cases who have mal-prognosic chromosome, the complication of organ damage show the higher death risk.
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