Treatment of Acute Lymphoblastic Leukemia in Adolescents and Young Adults.

Treatment outcomes have significantly improved for children with acute lymphoblastic leukemia (ALL), a relatively common childhood cancer, with 5-year survival rates over 80%. However, survival rates for adolescents and young adults (AYAs) with ALL are lower than that for their younger counterparts. Despite marked heterogeneity in the biology of ALL, advancing age appears to be associated with an increased incidence of prognostically unfavorable cytogenetic abnormalities and a decreased incidence of favorable cytogenetic abnormalities. Retrospective analyses indicate that AYAs display superior remission and survival rates when treated with a pediatric rather than an adult protocol. This is thought to, in part, reflect differences in drug selection and dose intensity, with typical pediatric treatment regimens incorporating higher total doses of vincristine, l-asparaginase, and glucocorticoids than adult regimens, which tend to use more myelosuppressive agents. The tolerability and efficacy of intensive pediatric regimens are being tested prospectively in the AYA population. This review will describe the biology, treatment approaches, and therapy-related toxicities for AYAs with ALL.