title: Treatment of acute lymphoblastic leukemia in adolescents and young adults.
abstract: Treatment approaches for adolescents and young adults with acute lymphoblastic leukemia (ALL) have evolved considerably in the past 5-7 years. One of the major changes has been the widespread adoption of pediatric-based protocols, which appears to have significantly improved survival and probably renders allogeneic hematopoietic stem cell transplantation (HSCT) unnecessary in most standard-risk patients. However, high-risk patients, such as those with BCR-ABL or MLL rearrangements or high white count presentations, should still be referred for HSCT in CR-1. Minimal residual disease positivity has also been identified as a high-risk feature. Patients with BCR-ABL-positive ALL should receive combined therapy with a tyrosine kinase inhibitor and chemotherapy prior to HSCT. The adoption of pediatric-based regimens has been associated with significant additional toxicities, including venous thromboembolism, osteonecrosis, other steroid-related changes, and neuropathy, which can potentially have a major adverse impact on the quality of life of these young ALL patients.
authors: Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Ontario, Canada. joseph.brandwein@uhn.on.ca
authors: Joseph M
authors: JM
authors: Brandwein
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D016044:Fusion Proteins, bcr-abl; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D018365:Neoplasm, Residual; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D016044:Fusion Proteins, bcr-abl