Acute lymphoblastic leukemia in adolescents and young adults

Abstract

Acute lymphoblastic leukemia (ALL) in the adolescent and young adult (AYA) population is a difficult clinical problem. The AYA population, generally regarded as patients aged 15 to 39 years, currently draws a good deal of attention, particularly in the area of therapy selection. The current trend is to treat this group of patients with leukemia regimens based on pediatric protocols, and results comparing pediatric approaches versus adult approaches to treatment are maturing. Results are pending from a large US trial in which pediatric-based treatment is given to AYA patients with ALL. In tandem with these new clinical trials, researchers have reported disease features in the AYA group that may explain some of the differences in response to treatment observed in the AYA population compared with the pediatric population. In addition, unique social factors in this age group add to the complexity of ALL therapy in the AYA population. AYA patients are developing independence and separating from their parents. They tend to be noncompliant. Young adults suffer from a lack of health care insurance and poor access to clinical trials, and have specific concerns regarding toxicities, in particular fertility. Cancer 2017;123:2398-403. © 2017 American Cancer Society.

ENO2 Promotes Cell Proliferation, Glycolysis, and Glucocorticoid-Resistance in Acute Lymphoblastic Leukemia

“…In the past decade, the treatment of ALL has made significant progress in understanding the pathogenesis of disease, predicting prognosis, and developing new therapies. The application of targeted therapy significantly improved the survival of patients with ALL [5-8]. Further improvements in the outcome of ALL therapy require the development of novel, targeted and low toxic therapies.…”

Toward the potential cure of leukemias in the next decade

“…This was the case with the hyper-CVAD regimen (hyper-fractionated cyclophosphamide, vincristine, doxorubicin [Adriamycin], and dexamethasone alternating with methotrexate and cytarabine) and the pediatric regimens applied to adolescents and young adults. 89,90 The difference in outcome between adult and pediatric patients with ALL is attributable to 4 subcategories that have different incidences in the 2 age groups. [88][89][90][91] ALL with hyperdiploid karyotype and ETS variant 6-runt-related transcription factor 1 (ETV6-RUNX1) translocations, both of which are favorable categories, constitute 25% each of pediatric ALL but <5% each of adults.…”

“…89,90 The difference in outcome between adult and pediatric patients with ALL is attributable to 4 subcategories that have different incidences in the 2 age groups. [88][89][90][91] ALL with hyperdiploid karyotype and ETS variant 6-runt-related transcription factor 1 (ETV6-RUNX1) translocations, both of which are favorable categories, constitute 25% each of pediatric ALL but <5% each of adults. Ph-positive ALL, an entity with an unfavorable prognosis until recently, comprises 25% of adult ALL but only 5% of pediatric cases.…”

Use of recommended posttreatment services for adolescent and young adult survivors of Hodgkin lymphoma

“…This suggests that for these 8 patients, pediatric oncologists were involved in comanaging the care of patients diagnosed between ages 15 and 18 years with their adult oncology colleagues via multicenter tumor boards or other avenues of communication that were not captured in our data sources, and/or that patients or physicians traveled between different centers. It has been shown that some AYA patients with cancer, such as those diagnosed with acute lymphoblastic leukemia, have improved event‐free and overall survival when treated with pediatric protocols, although a minority of AYA patients with acute lymphoblastic leukemia receive pediatric regimens . A recent study found improved outcomes for AYA patients with HL who are treated with a pediatric protocol compared with those treated with an adult protocol .…”

“…It has been shown that some AYA patients with cancer, such as those diagnosed with acute lymphoblastic leukemia, have improved event-free and overall survival when treated with pediatric protocols, 34,35 although a minority of AYA patients with acute lymphoblastic leukemia receive pediatric regimens. 36 A recent study found improved outcomes for AYA patients with HL who are treated with a pediatric protocol compared with those treated with an adult protocol. 37,38 The results of the current study suggest that treatment by a pediatric oncologist is associated with a higher likelihood of receiving recommended posttreatment care, although this occurred among a small number of patients.…”