Acute Lymphoblastic Leukemia

Abstract

The incidence of acute lymphoblastic leukemia (ALL) in the AYA population has increased more in the recent decades than it has in younger or older age groups, the cause of which is unknown. While survival rates in the pediatric population have improved dramatically, outcomes have not improved as much in AYAs, and as of a decade ago, only half of the AYA ALL patients were surviving 5 years. There is mounting evidence that the “pediatric” treatment approach may be more favorable for this age group compared to traditional “adult” ALL treatment regimens. Hospitalizations are not required for the therapy, it is less toxic, and may be expected to have fewer adverse late effects. These regimens are quite intense, but on balance, the risk/benefit profile appears to favor the use of these more intense regimens in order to achieve superior outcomes with less residual morbidity. Biologically, the Ph-like subset may provide an “AYA ALL” approach to ALL therapy in the age group since Ph-like ALL has a peak incidence in AYAs and specific targeted agents are clinically available for a subset of these patients. An appreciation for the complex psychosocial underpinnings in these patients is paramount, in order to maximize compliance with the prolonged and complex treatment plans that must be implemented during the crucially formative AYA years.