Age remains probably the most important prognostic factor in acute lymphoblastic leukemia (ALL). Adults with ALL have poor outcome with chemotherapy when compared to children; as age increases overall survival (OS) continuously declines. Elderly ALL (EALL) patients (pts) have the worst outcome with chemotherapy. Despite good initial response to induction chemotherapy, relapse rate (RR) is high and most pts will succumb to their disease. Few studies have addressed the outcome of EALL with chemotherapy. Retrospective analysis of 32 EALL pts treated with chemotherapy at the L/BMT program of BC, Canada between 1989-2008. EALL was defined by age ≥60 years. Cytogenetics was available on 28(87.5%) pts. All pts received a consistent induction/consolidation and maintenance chemotherapy as per our modified ALL89-01 protocol. Complete remission (CR), Event free survival (EFS) and OS were analyzed. Betwen1989-2008, 32 pts (8.7% of adult ALL) were EALL, median age 66.0(60.1-76.1) years, 50% males. Median wbc count was 7.4(0.8-43) x109/L. 7/32(28%) were Ph+. Only one pt had CNS involvement. All pts received a consistent induction with daunorubicin, vincristine and prednisone. 27/32(84.4%) achieved CR. 18/27(66.7%) of pts. who achieved CR received phase II induction consisting of cyclophosphamide, cytarabine, and mercaptopurine. Consolidation chemotherapy was given in 17/27 (62.9%), in 15/17(88.2%) consisted of 1-2 cycle of cytarabine and tenoposide. 6 pts also received modified intensification with vincristine, daunorubicin, cyclophosphamide. 4 pts received tyrosine kinase inhibitor (TKI) with consolidation. 2 pts received other chemotherapy. Maintenance with methotrexate and mercaptopurine were given in 20 pts which include 4 pts who did not receive consolidation. 23/27(85.2%) pts who achieved CR had relapse. Median time to relapse from diagnosis is 240(112-1317) days. Median EFS and OS are 313(0-1317) and 489(38-1770) days, respectively. Cause of death was disease progression in 25/27 (92.6%). 6/7(85%) of Ph+ pts received combination chemotherapy with TKI. 3-year OS for the whole group was 26%, 36% for Ph+ pts and 23% for Ph- ALL. EALL have poor outcome with chemotherapy. Despite the excellent CR rate with chemotherapy (84.4%), RR remains high (85.2%) and most patients (96.2%) die secondary to DP. In the TKI's era, EALL with Ph+ disease relatively fair better than Ph- EALL.Tabled 13-year disease free survival and over all survivalAll PatientPh+ groupPh- groupP valueNumber327253-year DFS15%0%19%0.203-year-OS26%36%23%0.81 Open table in a new tab