Management of acute lymphoblastic leukemia in older adults

Acute lymphoblastic leukemia, commonly known to affect the younger population, is a disease that is affecting the elderly in an increasing amount as the human life span continues to lengthen. Traditional cytotoxic agents are intolerable to elderly individuals owing to comorbidities, weakened immune systems, and organ dysfunction. Alternative agents and regimens are needed to allow for elderly patient to tolerate full cycles of therapy while providing complete and durable remissions. With the advent of targeted agents, such as monoclonal antibodies and bispecific T-cell engagers, a number of options have proven themselves to be effective in the elderly and optimal for tolerability. Here, we review and discuss the literature addressing regimens that use new agents, such as blinatumomab, inotuzumab ozogamicin, and venetoclax, and those that use modified dosing strategies of traditional chemotherapy.