Individual management of acute lymphoblastic leukaemia in adolescents and young adults
Dr Josep Ribera - Catalan Institute of Oncology, Barcelona, Spain
My presentation will deal on a specific age range of treatment in ALL that are adolescents and young adults. They are not children, they are not older adults so are in the middle, in the middle of success and in the middle of not success. So this is a specific age range that deserves special attention.
How are these patients managed currently?
There is a consensus that these patients should be best managed with paediatric protocols, full paediatric or paediatric inspired protocols, but the paediatric way of treating ALL should be done to these patients. But they have tolerability issues, they have specific issues derived from the background, the genetic background, of the disease that the results are not the same as expected or shown in paediatric trials in children.
What kind of genetic changes do they have?
They have less genetic situations or less genetic features with good prognosis and some genetic features with poor prognosis and they are in the inter-cross. So, for example, adolescents and young adults have low hyperdiploidy, low [?? 1:56] rearrangement, low Ph positive. So these characteristics that make ALL in paediatrics successful are not fully presented in adolescents and young adults. And also the new genetically defined subtypes of ALL such as BCR-ABL, so like ALL, early pre-T ALL, Ph positive ALL, are more frequent in adolescents and young adults than in children. This is important for the results of the therapy.
How can we manage patients more effectively?
I think that in the future we have to make a good management at baseline of these patients. We have to identify at baseline the genetic features that are related to a poor prognosis and for these specific genetic lesions include these patients in clinical trials with new drugs. This is one.
The second management is to optimise the paediatric protocol, the current paediatric protocols. We can use more asparaginase in the adolescents and young adults. We have to introduce the immunotherapy in earlier phases of the disease to use, for example, for Ph positive ALL newer and more potent tyrosine kinase inhibitors. So we have to translate the improvements in the therapy to earlier phases of the paediatric trial.
Finally, we have to treat these patients especially with adolescents and young adult units or in paediatric adult joint teams because we will take experience and management from adults from paediatricians and paediatricians from adults and we will improve the results. This latter part is also important.