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All-optical Mechanobiology Interrogation of Yes-associated Protein in Human Cancer and Normal Cells using a Multi-functional System
Published on: December 20, 2021
New developments in ALL in AYA
1Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France.
Insights
Outcomes for adolescents and young adults with acute lymphoblastic leukemia (ALL) are improving with targeted therapies. Advances in ALL biology and risk stratification offer new hope for better treatment strategies and reduced toxicity.
Area of Science:
- Hematology
- Oncology
- Pediatric Oncology
Background:
- Outcomes for adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) have improved due to pediatric-inspired protocols.
- Treatment resistance and toxicity increase with age, necessitating novel therapeutic approaches.
- Advances in ALL biology, risk stratification, and targeted therapies are crucial for further progress.
Purpose of the Study:
- To review recent advancements in the treatment of ALL in adolescents and young adults.
- To highlight the importance of understanding ALL biology for personalized treatment strategies.
- To discuss the role of targeted therapies, immunotherapy, and minimal residual disease monitoring in improving outcomes.
Main Methods:
- Review of current literature on ALL treatment in AYA.
- Analysis of recent biological and genetic discoveries in ALL.
- Evaluation of the impact of novel therapeutic strategies, including targeted small molecules and immunotherapy.
- Assessment of the role of minimal residual disease (MRD) monitoring and comprehensive care programs.
Main Results:
- The proportion of B-cell precursor ALL with "B-other" genetic drivers in AYA has significantly decreased.
- Philadelphia-like ALL is a common high-risk subtype in AYA, presenting numerous actionable targets.
- Early MRD monitoring is essential for risk stratification and guiding treatment decisions, including allogeneic stem cell transplantation.
- Frontline immunotherapies are being employed to eradicate MRD and improve outcomes for high-risk patients.
Conclusions:
- Further improvements in AYA ALL treatment rely on integrating advanced biological insights, precise risk stratification, and novel targeted therapies.
- Timely identification of actionable targets, particularly in Philadelphia-like ALL, remains a challenge.
- Immunotherapies and MRD monitoring are pivotal in enhancing treatment efficacy and reducing toxicity.
- Comprehensive care programs are vital for supporting AYA patients throughout their cancer journey.
Abstract:
The outcome for adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) has improved, mostly based on the use of pediatric-inspired intensive protocols. Due to increasing disease resistance and treatment-related toxicity with age, further improvements are now expected from the expanding knowledge of ALL biology, more accurate risk stratification, and the early introduction of targeted small molecules and immunotherapy. In the last decade, the rate of AYA with B-cell precursor ALL with undetermined genetic drivers ("B-other") has shrunk from 40% to fewer than 10%. The high-risk subgroup of Philadelphia-like ALL is the most frequent entity diagnosed in this age range, offering a multitude of potentially actionable targets. The timely and accurate identification of these targets remains challenging, however. Early minimal residual disease (MRD) monitoring has become a standard of care for the risk stratification and identification of patients likely to benefit from an allogeneic hematopoietic stem cell transplantation. Recently approved immunotherapies are moving frontline to eradicate MRD, to improve the outcome of high-risk patients, and, eventually, to reduce treatment burden. Comprehensive care programs dedicated to AYA with cancer aim at improving inclusion in specific clinical trials and at giving access to appropriate psychosocial support, fertility preservation, and survivorship programs.
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