Treatment of Acute Lymphoblastic Leukemia in Young Adults

Abstract

Over the last 3 decades, progress in the treatment of acute lymphoblastic leukemia (ALL) in children has dramatically improved the outcome of patients, leading to cure rates of more than 80%. In adult ALL, the improvements in outcome have been modest with cure rates approximating 40%. In pediatric trials, patients older than 10 years of age are often considered high-risk patients and are treated more intensively. In adult trials, adolescents and young adults with ALL are considered as standard-risk patients and receive chemotherapy scheduled for patients up to 60 years of age. These divergent treatment approaches in adolescents led many pediatric and adult groups to compare their results in this subgroup of patients and to conclude that adolescents may benefit from treatment with pediatric regimens. In young adults, recent studies have demonstrated that outcome may be improved by pediatric-inspired reinforced chemotherapeutic strategies but also by allogeneic transplantation. In this chapter focusing on ALL in young adults, we summarize the specific biologic characteristics of the disease and the results of recent adult protocols. Therapeutic strategies inspired from pediatric approaches will be emphasized. The development of collaborative trials in optimized psychosocial environments will be required to steadily improve the results in this population of young adults.KeywordsAcute Myeloid LeukemiaAcute Lymphoblastic LeukemiaMinimal Residual DiseaseAllogeneic Stem Cell TransplantationComplete Remission RateThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.