title: Rationale for a pediatric-inspired approach in the adolescent and young adult population with acute lymphoblastic leukemia, with a focus on asparaginase treatment.
abstract: In the last two decades great improvements have been made in the treatment of childhood acute lymphoblastic leukemia, with 5-year overall survival rates currently approaching almost 90%. In comparison, results reported in adolescents and young adults (AYAs) are relatively poor. In adults, results have improved, but are still lagging behind those obtained in children. Possible reasons for this different pattern of results include an increased incidence of unfavorable and a decreased incidence of favorable cytogenetic abnormalities in AYAs compared with children. Furthermore, in AYAs less intensive treatments (especially lower cumulative doses of drugs such as asparaginase, corticosteroids and methotrexate) and longer gaps between courses of chemotherapy are planned compared to those in children. However, although favorable results obtained in AYAs receiving pediatric protocols have been consistently reported in several international collaborative trials, physicians must also be aware of the specific toxicity pattern associated with increased success in AYAs, since an excess of toxicity may compromise overall treatment schedule intensity. Cooperative efforts between pediatric and adult hematologists in designing specific protocols for AYAs are warranted.
authors.affiliation: Pediatric Hematology-Oncology Unit Department of Pediatrics, University of Milan-Bicocca , Monza, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Rizzari
authors.affiliation: Pediatric Onco-Hematology Unit, Clinic of Pediatrics , Padua, Italy.
authors.forename: Maria Caterina
authors.initials: MC
authors.lastname: Putti
authors.affiliation: Pediatric Hematology-Oncology Unit Department of Pediatrics, University of Milan-Bicocca , Monza, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Colombini
authors.affiliation: Pediatric Hematology-Oncology Unit Department of Pediatrics, University of Milan-Bicocca , Monza, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Casagranda
authors.affiliation: Pediatric Hematology-Oncology Unit Department of Pediatrics, University of Milan-Bicocca , Monza, Italy.
authors.forename: Giulia Maria
authors.initials: GM
authors.lastname: Ferrari
authors.affiliation: Institute of Hematology, University of Bologna , Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Papayannidis
authors.affiliation: Institute of Hematology, University of Bologna , Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Iacobucci
authors.affiliation: Institute of Hematology, University of Bologna , Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Abbenante
authors.affiliation: Institute of Hematology, University of Bologna , Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Sartor
authors.affiliation: Institute of Hematology, University of Bologna , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Martinelli
keywords: acute lymphoblastic leukemia; adolescent; asparaginase; young adult