The current approach and the treatment of adolescents and young adults with acute lymphoblastic leukemia

Abstract

Introduction. The treatment outcome of adolescents and young adults with acute lymphoblastic leukemia is much poorer in contrast to pediatric patients. By changing the concept of the treatment for patients who are adolescents and young adults with acute lymphoblastic leukemia, especially with the use of pediatric regimens, significant improvement in survival has been made (current 5-year survival rate goes up to 70%). Contributing factors for different outcomes between children and adolescents and young adults with acute lymphoblastic leukemia. Beside the differences between pediatric and adult protocols, there are several factors which can explain the different outcomes between these groups of patients with acute lymphoblastic leukemia. One of the main factors is different biology of the leukemias and, on the other side, lower accrual rates in clinical trials in adolescents and young adults and their specific psychosocial factors, like poor compliance with the treatment and missed appointments. Current treatment and novel approaches in the treatment of adolescents and young adults with acute lymphoblastic leukemia. Current treatment approach to the adolescent and young adults with acute lymphoblastic leukemia is based on the pediatric protocols with the risk-adapted strategy, which depends primarily on the cytogenetics and postinduction minimal/measurable residual disease. The main goal of the novel treatment, especially with the use of targeted therapy and innovative immunotherapies incorporated in the pediatric protocols, is to achieve a deep and durable leukemia-free survival. To transplant or not to transplant adolescents and young adults with acute lymphoblastic leukemia is still a matter of debate, particularly in the era of pediatric regimens and the new sequence algorithm with the upfront use of novel drugs. Conclusion. Adolescent and young adult patients with acute lymphoblastic leukemia should be treated in specialized centers by an experienced multidisciplinary team with close attention to their particular needs.