How would you treat an older patient with pancytopenia who was diagnosed with ALL?

Here’s how readers responded to a You Make the Call question about treating a patient with acute lymphocytic leukemia who is of advanced age.

Disclaimer: ASH does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this article is solely at your own risk.

Given his age and the non-curable status of ALL in a very old patient, I would consider only supportive care and a POMP-like schema if needed.

Jorge David Korin, MD
Buenos Aires, Argentina

Low-dose vincristine and prednisone are feasible. But blinatumomab would be a good option.

Rayaz Ahmed, MD
Rajiv Gandhi Cancer Institute & Research Centre
New Delhi, India

I agree with prednisone and vincristine, which is in line with an Italian study that showed response and survival in older patients similar to more intense conventional therapy. If available, I would add blinatumomab at least as a trial and monitor closely for toxicity.

Michael Pidcock, MBBS
Canberra, Australia

Starting with low doses of vincristine and prednisone is appropriate. Afterward, according to performance status, results, and tolerance, it is possible to use different  therapeutic approaches as suggested.

Giulio De Rossi, MD
Rome, Italy

Because of lack of equipment and medicines, we treat high-risk patients with vincristine and prednisone.

Ahmad Walid Yousufzai, MD
Jamhuriat Hospital
Kabul, Afghanistan