Where should adolescents with ALL be treated?

Area of Science:

• Hematology
• Oncology
• Adolescent Medicine

Background:

• Adolescents with acute lymphoblastic leukemia (ALL) are treated by both pediatric and adult teams, often under different protocols.
• Outcomes for adolescents with ALL are poorer than for children but better than for adults, suggesting age-specific factors influence treatment response.
• Differences in treatment protocols, supportive care, and HSCT indications exist between pediatric and adult ALL management.

Purpose of the Study:

• To review treatment outcomes for adolescents with ALL undergoing first-line chemotherapy and hematopoietic stem cell transplantation (HSCT).
• To identify factors contributing to outcome disparities between adolescents, children, and adults with ALL.
• To propose strategies for improving treatment and research for adolescent ALL.

Main Methods:

• Review of first-line chemotherapy and HSCT outcomes in adolescents with ALL.
• Comparison of results from pediatric versus adult clinical trials for adolescent ALL patients.
• Analysis of disease biology, host factors, and treatment-related variables.

Main Results:

• Adolescents in pediatric trials show better outcomes than those in adult trials, attributed to protocol design, dose intensity, HSCT use, and supportive care.
• HSCT outcomes for adolescents are poorer than for children but better than for adults, with differing indications for HSCT in CR1 between age groups.
• Psychosocial support and physical activity are identified as areas for improvement in adolescent ALL care.

Conclusions:

• Adolescents with ALL benefit from enrollment in pediatric-focused trials and treatment by experienced teams.
• Risk-based strategies and redefined age limits, alongside multicenter cooperation, are crucial for advancing adolescent ALL care.
• Enhanced psychosocial support and physical activity interventions are necessary challenges for multidisciplinary teams treating adolescents with ALL.