How I Treat Adult Acute Lymphoblastic Leukemia in India

Abstract

Survival of children with acute lymphoblastic leukemia (ALL) has improved from 10% to 90% over the last six decades. Survival gains in adult ALL have been more modest and confined to the adolescent and young adult population. Age is an important factor in determining outcomes in ALL. Additional factors like adverse biology, less intense treatment regimens, and poorer tolerance to therapy contribute to inferior survival among adults. Indian physicians face unique challenges while managing these patients. These are high infection rates, limited access to high-end investigations, and newer drugs. In this context, the management decisions in an individual patient are highly nuanced. Through a case-based review, we discuss representative scenarios in adult ALL where we detail our current approach to treatment in the context of available evidence.

What Does an Adult Hemato-Oncology Physician Expect from a Hematopathologist?

“…Adult ALL: Survival gains are modest except in the adolescent and young adult (AYA) population. 12 More intense therapies based on pediatric protocols are preferred in the AYA population. About 15 to 25% of adults would be Ph + , where targeted therapy with TKIs is incorporated.…”