The current treatment approach to adolescents and young adults with acute lymphoblastic leukemia (AYA-ALL): challenges and considerations

Abstract

Introduction: AYA-ALL differs from pediatric ALL in terms of clinical, biological, psychosocial factors and access to care and has an inferior outcome. It is now being recognized that pediatric-inspired protocols are superior to adult protocols for this cohort, but given the lack of randomized trials, several questions remain unanswered.

Areas covered: In this review, we discuss how AYA-ALL is different from the pediatric ALL population, compare AYA-ALL with ALL in middle and older age adults, review the studies that have enrolled the AYA cohort, summarize risk-stratified and response-adapted approaches, describe the biological subtypes, and review the novel agents/approaches under evaluation.

Expert opinion: AYA-ALL is a complex and challenging disease that needs multidisciplinary and focused care. Well-designed clinical trials that focus on this cohort are needed to further improve the outcomes.

Keywords: Adolescent and young adult; Ph-like ALL; Ph-positive ALL; acute lymphoblastic leukemia; early T precursor-ALL; minimal residual disease; risk-stratification.