scholarly journals Acute Lymphoblastic Leukemia in Adolescents and Young Adults in Finland.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1885-1885
Author(s):  
Anu Usvasalo ◽  
Ulla Saarinen-Pihkala ◽  
Erkki Elonen ◽  
Riikka Raty ◽  
Kim Vettenranta
Keyword(s):  
Young Adults ◽  
Risk Factor ◽  
Acute Lymphoblastic Leukemia ◽  
Treatment Group ◽  
Lymphoblastic Leukemia ◽  
Age Groups ◽  
Total Duration ◽  
Cell Transplant ◽  
Adult Treatment ◽  
Term Survival

Abstract Background: Long-term survival in pediatric acute lymphoblastic leukemia has dramatically improved during the past three decades through intensification of therapy. Progress has also been made regarding therapy of adult ALL. Recent reports in the literature suggest better outcome on pediatric protocols, as compared with adult ones. In pediatric ALL, age over 10 years is a high-risk factor in many protocols. The arbitrary age limit of 16 years may not truly reflect the biologic differences in ALL between adolescents vs. young adults. The purpose of the present work was to evaluate the outcome of adolescents with ALL in Finland, treated on pediatric vs. adult ALL protocols. Materials and methods: All patients aged 10–25 years diagnosed with ALL during 1990–2005 in Finland were included. There were 120 patients (aged 10–16 yrs) treated on pediatric common Nordic (NOPHO) protocols with a total duration of 2 yrs, and 100 patients (aged 17–25 yrs) treated on Finnish National ALL adult protocols with a total duration of 3.5 yrs. In total 15 underwent allo-SCT in first remission. Data had been collected to the pediatric Nordic NOPHO database, as well as to the Finnish Leukemia Group ALL database. Events were defined as death, relapse, or second malignancy. Results: The 5-year EFS was 68 % for children (n=62) and 55% for adults (n=72) (p=0.04), and the 5-year OS was 75 % for children and 68 % for adults (p=0.075), respectively. When only patients treated with conventional chemotherapy were included (stem cell transplant recipients in 1CR excluded), the 5-year EFS was 65 % for children (n=53) and 55 % for adults (n=66) (p=0.09), and the 5-year OS was 80 % for children and 65 % for adults (p=0.09), respectively. Regardless of protocol, EFS in the age group of 10–15 years was 74 % and in the group 15–25 years 57 % (p=0,06). Conclusions: EFS regarding all patients was better on pediatric than on adult protocols. All the other comparisons reached statistically only a trend level. The difference in outcome between pediatric and adult protocols in Finland is less clear than reported elsewhere. Age seems to be a prognostic factor also in the adolescent age groups. The non-transplanted patients seemed to have a better outcome, suggesting that those with higher risk probably ended up with transplant. Although therapy is an important risk factor, our further analysis of cytogenetic features including CGH array may reveal other risk factors that may turn out to be even more powerful. EFS, pediatric vs. adult treatment group EFS, pediatric vs. adult treatment group

Adolescents and Young Adults with Acute Lymphoblastic Leukemia

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 21-29 ◽  
Author(s):  
Wendy Stock
Keyword(s):  
Young Adults ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Adolescents And Young Adults ◽  
Adult Treatment ◽  
Younger Adults ◽  
Disease Biology ◽  
Current Therapies ◽  
Long Term Survivors

Abstract During the last decade, increasing attention has been paid to a unique group of patients with acute lymphoblastic leukemia (ALL) who lie at the crossroad of therapeutic care by pediatric and adult hematologists/oncologists. ALL is a disease that affects infants, children, adolescents, and adult patients. With current therapies, the vast majority of children with ALL are now long-term survivors; unfortunately, the same good results have not yet been obtained for adults with ALL. This review will describe current controversies surrounding the treatment of adolescents and young adults with ALL—a group who finds themselves in the transition from “pediatric” to “adult” treatment approaches. The review focuses on recent insights into disease biology, prognostic factors, and treatment outcomes that have led to a series of prospective clinical trials specifically designed for adolescents and younger adults (AYAs) with ALL. These trials have been designed to provide important new clinical, psychosocial, and biological insights, and to further improve the survival of this challenging and unique group of patients.

scholarly journals Delays in Start of Intensification Therapy Are Common for Adults with Acute Lymphoblastic Leukemia, and Are Associated with Decreased Survival in Patients Who Undergo Allogeneic Stem Cell Transplant (SCT)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 208-208
Author(s):  
Anita J. Kumar ◽  
Phyllis A. Gimotty ◽  
Joel Gelfand ◽  
Georgina Buck ◽  
Jacob M. Rowe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Phase I ◽  
Multivariate Regression ◽  
Lymphoblastic Leukemia ◽  
Cell Transplant ◽  
Term Survival ◽  
Black Race ◽  
Female Sex ◽  
The Impact

Abstract Acute lymphoblastic leukemia (ALL) has a high relapse rate in adults. While the biology of the patient may be responsible for the marked difference in survival seen in comparison to children, variable adherence to complex chemotherapy regimens may also play a role. However, there is very little understanding about the risk factors for delays in therapy and the impact of delays on survival. To study delays in newly diagnosed adult ALL patients, we conducted an observational study using data from ECOG 2993/ MRC_UKALLXII (Rowe, Blood 2005). We analyzed Ph- patients who started intensification after documented complete remission (CR). A long delay (LD) was defined as > 98 days from start of induction to start of intensification (IS), which was >2 weeks delay beyond the 84 days recommended per protocol. A Very Long Delay (VLD) was defined as a >4 weeks delay. Of 2109 patients enrolled, 1247 patients met inclusion criteria for analysis. Of note, 435 Ph- patients who achieved CR after induction but did not proceed to intensification were excluded. In univariate analysis, female sex (p<0.001), Black race (p=0.01), and older age (p<0.001) were associated with increased odds of LD. During induction presence of infection (p=0.01), dose reductions (p=0.001), duration of neutropenia (p=0.007), thrombocytopenia (p<0.001), and hospitalization duration (p<0.001) were associated with LD. In multivariate regression, age, female sex, dose reduction, Black race, and hospitalization duration were significantly associated with LD and VLD (Table I). At 2 years after diagnosis, 801/1247 (64.2%) patients were alive. Of the surviving patients, 181 (22.5%) had VLD, and 620 (77.4%), had delay <4 weeks, p=0.073. Of the alloHCT patients, 333 were alive: 57/333 (17%) had VLD, and 276/333 (83%) had been delayed <4 weeks (p=0.036). As of July 2014, 687/1247 (55%) patients have died, with a median time to death from start of intensification of 13.3 months (range 0.8-231). Survival analysis was stratified by post-remission therapy, with living patients censored at date last seen. Patients who received myeloablative allogeneic HCT (allo HCT) had poorer overall survival from start of intensification (OS-IS) and event free survival (EFS-IS) after LD or VLD. While OS-IS and EFS-IS were significantly worse for alloHCT patients after VLD (p=0.02 and p=0.03) respectively, survival was not worse for non-transplant patients after VLD (p=0.24 and p=0.10) (Figure I). In a multivariate Cox regression, adjusting for other high-risk disease features (age, cell lineage, and white cell count at diagnosis), patients who underwent allo HCT had significantly worse OS-IS (HR 1.4, p=0.02) and EFS-IS (HR 1.4, p=0.02) after experiencing VLD compared to alloHCT patients who experienced <4 weeks delay. When evaluating OS and EFS from diagnosis, VLD was still associated with poorer OS (HR 1.34, p=0.04) and EFS (HR 1.34, p=0.03). There was no difference in OS or EFS in patients who received non-transplant post-remission therapy based on delay. In a comprehensive analysis of the largest adult ALL study ever reported, we identified significant risk factors predictive of LD and VLD (>2 and >4 weeks beyond mandatory rest period). Our findings highlighted that patients were delayed because of chemotherapy toxicity and also identified healthcare disparities. VLD was associated with poorer OS and EFS in patients undergoing alloHCT, but not in patients undergoing non-transplant post remission therapy. Further studies are planned to prospectively identify patient barriers to on-schedule treatment with a goal of earlier intervention. The ability to better predict and intervene on risk factors for delay can improve adherence to protocol and optimize long-term survival. Table I: Multivariate Regression for LD and VLD Risk Factors Variable Odds Ratio 95% Confidence Interval p-value Days in the hospital Phase I Induction 1.01 1.00-1.02 0.04 Duration of Thrombocytopenia, Phase I 1.02 1.01-1.03 0.001 Age by Decade 1.2 1.08-1.31 <0.001 Reduced Dose in Induction 1.54 1.08-2.22 0.019 Sex, Female 1.56 1.22-2.0 <0.001 Race, Black 3.4 1.41-7.96 0.006 Figure 1 Figure 1. p=0.023 Disclosures No relevant conflicts of interest to declare.

Survival Improvements Following Myeloablative Allogeneic Hematopoietic Cell Transplantation For Acute Lymphoblastic Leukemia In Adolescents and Young Adults Have Been Comparable To Younger Children: A Study From The Cibmtr

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 554-554
Author(s):  
William A. Wood ◽  
Stephanie J. Lee ◽  
Ruta Brazauskas ◽  
Zhiwei Wang ◽  
Mahmoud D. Aljurf ◽  
...  
Keyword(s):  
Older Adults ◽  
Overall Survival ◽  
Young Adults ◽  
Acute Lymphoblastic Leukemia ◽  
Peripheral Blood ◽  
Hematopoietic Cell Transplantation ◽  
Lymphoblastic Leukemia ◽  
Age Groups ◽  
Time Periods ◽  
Over Time

Abstract Adolescents and young adults (AYAs) with cancer have not experienced survival improvements over time to the same extent as younger and older patients. Studies in acute lymphoblastic leukemia (ALL) have identified differences in chemotherapy treatment approaches, adherence and possibly outcomes for AYAs treated in pediatric vs. adult settings. To determine if these same issues are operative in ALL patients treated with hematopoietic cell transplantation (HCT), we compared outcomes among 2730 patients including 1008 children (<15 years), 1244 AYAs (15-40 years) and 478 older adults (> 40 years) receiving myeloablative allogeneic HCT for ALL at US centers over three time periods (1990-1995, 1996-2001, and 2002-2007). All patients were in first or second complete remission at HCT; Ph+ patients were included; umbilical cord blood transplant recipients were excluded. The proportions of patients receiving peripheral blood transplants and receiving HCT using well-matched unrelated donors increased over time in all three age groups. From 1996-2001 to 2002-2007, transplant volume increased by 7% in children, 50% in AYAs, and 180% in older adults. Our analysis demonstrated that 5-year overall survival varied inversely with age group, but survival for AYAs over time improved at rates comparable to survival in children (Figure). Multivariate analyses adjusting for important patient and disease characteristics confirmed that older age was associated with poorer survival (hazard ratio 2.2 for older adults and 1.7 for AYA vs. children, P<0.001); however, no significant interactions were observed between age and time period confirming that changes in survival rates over time were similar between the groups even after statistical adjustment for other factors. Similar findings were observed for transplant-related mortality (TRM) and relapse. Transplantation techniques and outcomes were also explored for a subset of 131 AYAs (ages 15-25) transplanted at 46 pediatric or 92 adult centers. Although limited by small numbers, univariate analyses did not show differences in probabilities of overall survival, TRM, or relapse by center type. Patients transplanted at pediatric centers had a longer time from diagnosis to transplant than patients transplanted at adult centers (p=0.024), and were more likely to receive bone marrow vs. peripheral blood stem cell graft (p<0.001). Conditioning regimens (p=0.04) and GVHD prophylaxis (p<0.01) also differed. Taken together, these findings suggest that, in contrast to what has been observed for other cancers over time, survival following myeloablative allogeneic HCT for AYA’s has improved at a rate comparable to other age groups. There appear to be differences in transplant timing and techniques for AYAs depending on whether treatment occurs in a pediatric or adult center but transplant outcomes did not significantly differ, in contrast to survival differences reported in the non-transplant setting. In summary, AYAs are experiencing improvements comparable with younger children, and appear to have similar outcomes whether transplanted at pediatric or adult centers.Figure5-year adjusted overall survival probabilities for the three age-groups and time periods. Boxes represent estimates (center lines) and 95% confidence intervals.Figure. 5-year adjusted overall survival probabilities for the three age-groups and time periods. Boxes represent estimates (center lines) and 95% confidence intervals. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Clinical Outcomes of Adults and Young Adults (AYA) with Acute Lymphoblastic Leukemia (ALL): A Multicenter Analysis of Pediatric-Inspired Protocol (MASPORE) Vs Hyper-CVAD in Singapore

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1238-1238
Author(s):  
Sai Lon Wann ◽  
Tertius Tuy ◽  
Victor Ling Wei Teik ◽  
Christian Gallardo ◽  
Lip Leong Chong ◽  
...  
Keyword(s):  
Young Adults ◽  
Stem Cell ◽  
Retrospective Study ◽  
Acute Lymphoblastic Leukemia ◽  
Treatment Option ◽  
Stem Cell Transplant ◽  
Lymphoblastic Leukemia ◽  
Asian Population ◽  
Cell Transplant ◽  
Hematopoietic Stem

Abstract Introduction: In acute lymphoblastic leukemia (ALL) adolescents and young adults (AYA), there are benefits when using pediatric over adult treatment regimes. There is improved overall survival (OS), progression free survival (PFS) and reduced need for hematopoietic stem cell transplantation; all while having an acceptable toxicity profile. Yet, studies supporting this were largely performed in a western population (e.g., United Kingdom and United States) and thus may have had limited representation of the Asian population. Whether these results are generalizable and applicable to an Asian population is in question. MASPORE, a locally designed pediatric regiment based on BFM regimen, which has been used successfully in Singapore and Malaysia's AYA cohort since 2007. MASPORE protocol utilized PCR-based minimal residual disease (MRD) marker to risk stratify patients according to disease severity and used a 3- or 4-drug induction regimen depending on intermediate or high-risk stratification (L-asparaginase, Vincristine, Dexamethasone +/- daunorubicin). In contrast HyperCVAD does not use MRD to stratify or guide management. In this retrospective study performed in Singapore, we aim to demonstrate that MASPORE is an effective treatment option for AYA ALL in Asian population. Methods: Patient registries (IRB approved) spanning from January 2005 to June 2021 from three tertiary hospitals in Singapore were reviewed. ALL patients who were AYA, defined as less than 40 years of age, treated during this time were included and analyzed. Patients were treated with either the pediatric protocol MASPORE or with the adult protocol HyperCVAD. Patients who are Philadelphia positive were excluded from the MASPORE arm up to 2020. Patients' demographics, functional status, risk profile, adverse events, as well as the hematological response and transplant status were collected and analyzed with Pearson chi-square test. Kaplan Meier curve analysis were performed for OS and PFS with SPSS software. Results: In this retrospective study, 116 patients were analyzed. Among these patients 29 (25%) received MASPORE and 87 (75%) received HyperCVAD. The median age was 23 (range 18-40) for MASPORE arm vs 28 years (range 15-40) for the HCVAD arm. median follow-up time was 4.5 vs 10.8 years. Both groups were similar in gender, race, ECOG status, and ALL risk status at diagnosis. Likewise, both arms did not have differences in starting hematological parameters: hemoglobin, total white blood cell count, platelet count, absolute neutrophil count, and bone marrow blast percentages. Median time from diagnosis to treatment was 3 and 4 days for MASPORE and HyperCVAD arms respectively. There were increased adverse rates for patients in the MASPORE arm. They had more (13.8 vs 0.0%, p &lt; 0.001) of which 75% of the pancreatitis were CTCAE grade 3/4, avascular necrosis (13.8 vs 2.2%, p = 0.016), cerebral venous thrombosis (13.8 vs 1.1%, p = 0.004) and other thrombosis (27.6 vs 5.7%, p = 0.004). For the MASPORE and HyperCVAD arms there was one induction death, one from sepsis and the other from pneumonia . Both arms managed to achieve complete response (CR) with equivalent rates (82.5 vs 80.5%, p = 0.752). However, there was less relapsed or refractory disease in those treated with MASPORE (10.3 vs 44.8%, p &lt; 0.001). The 5- OS was better in the MASPORE versus the HyperCVAD arm (4.4 vs 3.7 years; p = 0.049). Likewise, the 5-year PFS was superior in the MASPORE arm (4.2 vs 3.2 years, p = 0.034). Furthermore, a smaller proportion of patients required consolidative stem cell transplant (13.8 vs 49.4%, p &lt; 0.001). Conclusion: The pediatric-inspired protocol MASPORE achieved similar CR rates with OS and PFS benefit, reduced relapse rates, and less need for consolidative stem cell transplant. MASPORE serves as a viable treatment option when treating AYA patients with ALL. Larger prospective studies are needed to further explore its use. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals T-Cell Acute Lymphoblastic Leukemia—Current Concepts in Molecular Biology and Management

Biomedicines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1621
Author(s):  
Parveen Shiraz ◽  
Waqas Jehangir ◽  
Vaibhav Agrawal
Keyword(s):  
Young Adults ◽  
Acute Lymphoblastic Leukemia ◽  
T Cell ◽  
De Novo ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Cell Transplant ◽  
Cell Acute Lymphoblastic Leukemia ◽  
Children And Young Adults

T-cell acute lymphoblastic leukemia (T-ALL) is an uncommon, yet aggressive leukemia that accounts for approximately one-fourth of acute lymphoblastic leukemia (ALL) cases. CDKN2A/CDKN2B and NOTCH1 are the most common mutated genes in T-ALL. Children and young adults are treated with pediatric intensive regimens and have superior outcomes compared to older adults. In children and young adults, Nelarabine added to frontline chemotherapy improves outcomes and end of consolidation measurable residual disease has emerged as the most valuable prognostic marker. While outcomes for de-novo disease are steadily improving, patients with relapsed and refractory T-ALL fare poorly. Newer targeted therapies are being studied in large clinical trials and have the potential to further improve outcomes. The role of allogeneic stem cell transplant (HSCT) is evolving due to the increased use of pediatric-inspired regimens and MRD monitoring. In this review we will discuss the biology, treatment, and outcomes in pediatric and adult T-ALL.

scholarly journals Hyperlipidemia is a risk factor for osteonecrosis in children and young adults with acute lymphoblastic leukemia

Haematologica ◽  
2017 ◽  
Vol 102 (5) ◽  
pp. e175-e178 ◽  
Author(s):  
Signe Sloth Mogensen ◽  
Kjeld Schmiegelow ◽  
Kathrine Grell ◽  
Birgitte Klug Albertsen ◽  
Peder Skov Wehner ◽  
...  
Keyword(s):  
Young Adults ◽  
Risk Factor ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Children And Young Adults

Advances in the Genetics and Therapy of Acute Lymphoblastic Leukemia

2016 ◽  
pp. e314-e322 ◽  
Author(s):  
Sabina Chiaretti ◽  
Valentina Gianfelici ◽  
Susan M. O’Brien ◽  
Charles G. Mullighan
Keyword(s):  
Stem Cell ◽  
Acute Lymphoblastic Leukemia ◽  
T Cell ◽  
Stem Cell Transplant ◽  
Lymphoblastic Leukemia ◽  
Genetic Alterations ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Term Survival ◽  
Diverse Range

Acute lymphoblastic leukemia (ALL) remains an important cause of morbidity in children and adults. In this article, we highlight advances in the genetics and therapy of three key subtypes of ALL: T-cell ALL, BCR-ABL1 (Philadelphia [Ph] chromosone–positive), and Ph-like ALL. T-ALL is an aggressive disease that accounts for about 15% and 25% of ALL among pediatric and adult cohorts, respectively, and exhibits a multistep nature of cancer initiation and progression. The integration of cytogenetics, molecular biology, and immunophenotype analyses has led to the identification of defined T-ALL subgroups, such as early T-cell precursor ALL and novel lesions with a prognostic role, for which specific inhibitors are being developed. Ph–positive ALL was historically regarded as a subtype of ALL with a poor prognosis, and allogeneic stem cell transplant was recommended for all patients who could undergo this procedure. The deep complete responses seen with combination tyrosine kinase inhibitors (TKIs) and chemotherapy in Ph-positive ALL, and the reports of long-term survival among some patients not undergoing allogeneic stem cell transplant, has raised the question of whether there is a subset of patients who could be cured without this intervention. Ph-like ALL is a subtype of B-progenitor ALL common among older children and adults and associated with a diverse range of genetic alterations that activate kinase signaling. Ph-like ALL is also associated with poor outcome, for which precision medicine trials identifying kinase alterations and testing TKI therapy are being developed.

scholarly journals Treatment Complications and Survival Among Children and Young Adults With Acute Lymphoblastic Leukemia

2020 ◽  
Vol 16 (10) ◽  
pp. e1120-e1133 ◽  
Author(s):  
Elysia M. Alvarez ◽  
Marcio Malogolowkin ◽  
Jeffrey S. Hoch ◽  
Qian Li ◽  
Ann Brunson ◽  
...  
Keyword(s):  
Young Adults ◽  
Acute Lymphoblastic Leukemia ◽  
Inpatient Treatment ◽  
Cox Regression ◽  
Lymphoblastic Leukemia ◽  
Population Level ◽  
Induction Treatment ◽  
Term Survival ◽  
The Impact ◽  
All Treatment

PURPOSE: We previously demonstrated lower early mortality for young adults (YAs) with acute lymphoblastic leukemia (ALL) who received induction treatment at specialized cancer centers (SCCs) versus community hospitals. The aim of this study is to determine the impact of inpatient location of treatment throughout therapy on long-term survival, complications, and cost—associations that have not yet been evaluated at the population level. METHODS: Using the California Cancer Registry linked to a hospitalization database, we identified patients, 0-39 years of age, diagnosed with first primary ALL who received inpatient treatment between 1991 and 2014. Patients were classified as receiving all or part or none of their inpatient treatment at an SCC within 3 years of diagnosis. Inverse probability–weighted, multivariable Cox regression models estimated the associations between location of treatment and sociodemographic and clinical factors with survival. We compared 3-year inpatient costs overall and per day by age group and location of care. RESULTS: Eighty-four percent (0-18 years; n = 4,549) of children and 36% of YAs (19-39 years; n = 683) received all treatment at SCCs. Receiving all treatment at an SCC was associated with superior leukemia-specific (hazard ratio [HR], 0.76; 95% CI, 0.67 to 0.88) and overall survival (HR, 0.87; 95% CI, 0.77 to 0.97) in children and in YAs (HR, 0.71; 95% CI, 0.61 to 0.83; HR, 0.70; 95% CI, 0.62 to 0.80) even after controlling for complications. The cost of inpatient care during the full course of therapy was higher in patients receiving all of their care at SCCs. CONCLUSION: Our results demonstrate that inpatient treatment at an SCC throughout therapy is associated with superior survival; therefore, strong consideration should be given to referring these patients to SCCs.

scholarly journals Acute lymphoblastic leukemia in adolescent and young adults: treat as adults or as children?

Blood ◽  
2018 ◽  
Vol 132 (4) ◽  
pp. 351-361 ◽  
Author(s):  
Nicolas Boissel ◽  
André Baruchel
Keyword(s):  
Young Adults ◽  
Acute Lymphoblastic Leukemia ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Survival Rates ◽  
Age Distribution ◽  
Adolescent And Young Adult ◽  
Contributing Factors ◽  
Term Survival ◽  
Hematopoietic Stem

Abstract Adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) are recognized as a unique population with specific characteristics and needs. In adolescents age 15 to 20 years, the use of fully pediatric protocols is supported by many comparative studies of pediatric and adult cooperative groups. In young adults, growing evidence suggests that pediatric-inspired or even fully pediatric approaches may also dramatically improve outcomes, leading to long-term survival rates of almost 70%, despite diminishing indications of hematopoietic stem-cell transplantation. In the last decade, better knowledge of the ALL oncogenic landscape according to age distribution and minimal residual disease assessments has improved risk stratification. New targets have emerged, mostly in the heterogeneous B-other group, particularly in the Philadelphia-like ALL subgroup, which requires both in-depth molecular investigations and specific evaluations of targeted treatments. The remaining gap in the excellent results reported in children has many other contributing factors that should not be underestimated, including late or difficult access to care and/or trials, increased acute toxicities, and poor adherence to treatment. Specific programs should be designed to take into account those factors and finally ameliorate survival and quality of life for AYAs with ALL.

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