Who should be treating adolescents and young adults with acute lymphoblastic leukaemia?

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.