Abstract
Although several cancers have a peak incidence during adolescence and young adulthood,
the patients in this age group are arbitrarily referred to either paediatric or adult
oncologists and, consequently, treated on different protocols. Recent reports show
that paediatric oncologists are more likely to enroll patients in clinical trials,
and that adolescents who are treated on paediatric protocols have a better outcome
than their counterparts who are managed by adult oncologists. These observations were
also noted in adolescents with acute lymphoblastic leukaemia (ALL), a disease with
a bimodal peak incidence in early childhood and late adulthood. Recently, investigators
have become aware that patients in the adolescent and young adult age group might
be falling through the cracks because of the rigid organisation of the medical care
system. In this article, I present some of the current challenges in the treatment
of ALL in adolescents and young adults and propose strategies to improve outcome in
these patients.
Keywords
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References
- Children's Cancer Group trials in childhood acute lymphoblastic leukaemia.Leukemia. 2000; 14: 2223-2233
- Long-term results of total therapy studies 11, 12 and 13a for childhood acute lymphoblastic leukemia at St. Jude Children's Research Hospital.Leukemia. 2000; 14: 2286-2294
- Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia.J. Clin. Oncol. 2000; 18: 547-561
- A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukaemia.Blood. 1995; 85: 2025-2037
- Acute lymphoblastic leukemia.N. Engl. J. Med. 1998; 333: 605-615
- In vitro cellular drug resistance and prognosis in newly diagnosed childhood acute lymphoblastic leukemia.Blood. 1997; 90: 2723-2729
- Clinical significance of cytogenetic abnormalities in adult acute lymphoblastic leukemia.Blood. 1998; 91: 3995-4019
- Intensive chemotherapy for Philadelphia-chromosome-positive acute lymphoblastic leukaemia.Lancet. 1994; 343: 331-332
- Outcome of treatment in children with Philadelphia chromosome-positive acute lymphoblastic leukemia.N. Engl. J. Med. 2000; 342: 998-1006
- Clinical characteristics and treatment outcome of childhood acute lymphoblastic leukemia with the t(4;11)(q21;q23).Blood. 1991; 77: 440-447
- Six year follow up of the clinical significance of karyotype in acute lymphoblastic leukemia.Cancer Genet. Cytogenet. 1989; 40: 171-185
- Treatment of acute lymphoblastic leukemia in adolescents and young adults.in: Pui C.-H. Current Clinical Oncology: Treatment of Acute Leukemias: New Directions for Clinical Research. Humana Press, Totowa, NJ2002
- Prognostic factors in a multicenter study for treatment of acute lymphoblastic leukemia in adults.Blood. 1988; 71: 123-131
- Reduced folate carrier gene expression in childhood acute lymphoblastic leukemia.Clin. Cancer Res. 1998; 4: 2169-2177
- Accumulation of high levels of methotrexate polyglutamates in lymphoblasts from children with hyperdiploid (greater than 50 chromosomes) B-lineage acute lymphoblastic leukemia.Blood. 1992; 80: 1316-1323
- Decreased polyglutamination of methotrexate in acute lymphoblastic leukemia blasts in adults compared to children with this disease.Leukemia. 1993; 7: 1000-1004
- The biochemistry of P-glycoprotein-mediated multidrug resistance.Annu. Rev. Biochem. 1989; 58: 137-171
- Correlation of P-glycoprotein expression and function in childhood acute leukemia.Blood. 1996; 88: 309-318
- Differences in outcome in adolescents with acute lymphoblastic leukemia.J. Clin. Oncol. 2003; 21: 760-761
- Acute lymphoblastic leukaemia-progress in children, less in adults.N. Engl. J. Med. 1993; 329: 1343
- Young adults 16-21 years of age at diagnosis entered on Children's Cancer Group acute lymphoblastic leukemia and acute myeloblastic leukemia protocols.Cancer. 1993; 71: 3377-3385
- Nine years’ experience with “total therapy” of childhood acute lymphocytic leukemia.Pediatrics. 1972; 50: 246-251
- Acute lymphocytic leukemia in children.Cancer. 1975; 36: 770-774
- Acute lymphoblastic leukemia in childhood.Pediatr. Clin. North Am. 1988; 35: 903-932
- Long-term results of treatment studies for childhood acute lymphoblastic leukaemia.Leukemia. 2000; 14: 2276-2285
- Long-term results of total therapy studies 11, 12 and 13a for childhood acute lymphoblastic leukemia at St. Jude Children's Research Hospital.Leukemia. 2000; 14: 2286-2294
- Long-term results of four consecutive trials in childhood ALL performed by the ALL-BFM study group from 1981 to 1995.Leukemia. 2000; 14: 2205-2222
- Uniform approach to risk classification and treatment assignment for children with acute lymphoblastic leukemia.J. Clin. Oncol. 1996; 14: 18-24
- Acute lymphocytic leukemia in adults and children.Cancer. 1976; 37: 1256-1264
- Outcome of adolescents and young adults with ALL.Blood. 2000; 96: 467a
- Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials.J. Clin. Oncol. 2003; 23: 774-780
- Treatment of acute lymphoblastic leukemia in adults.J. Clin. Oncol. 1983; 1: 462-470
- Treatment of acute lymphoblastic leukemia in adults with intensive induction, consolidation, and maintenance chemotherapy.Blood. 1989; 73: 57-63
- Adult acute lymphoblastic leukemia.J. Clin. Oncol. 1989; 7: 58-66
Article info
Publication history
Accepted:
September 1,
2003
Received in revised form:
August 21,
2003
Received:
July 4,
2003
Identification
Copyright
© 2003 Elsevier Science Ltd. Published by Elsevier Inc. All rights reserved.
