Introduction: Treating ALL in Adult Patients

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Moderator Gary J. Schiller, MD, introduces a panel discussion focused on recent advances and unmet needs in the treatment of patients with acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia, and non-Hodgkin lymphoma. The conversation includes expert perspectives from John C. Byrd, MD, Dan Douer, MD, Stephen P. Hunger, MD, Brad S. Kahl, MD, and Michael C. Lill, MD.

Approximately 12% of leukemia diagnoses are ALL. In pediatric patients, the cure rate for ALL is nearly 90%; however, there is a worse prognosis for adult patients diagnosed with the disease. In general, explains Stephen P. Hunger, MD, the older a person gets the worse the prognosis.

In general, young children with ALL, below 10 years old, experience the best outcomes and highest cure rates. In general, each age range requires a different type of treatment, which makes establishing a standard difficult. Outside of pediatric patients, the next group is young adults; those below the age of 39, and older adults, who range in age from 40 to 60. Above that, are the very old adults, explains Dan Douer, MD.

As people age, biological changes in specific genes take place that alters outcomes, explains Hunger. In general, children present with favorable chromosome trisomies or RUNX1-ETV6 translocations, which makes treatment more effective. However, adults do not usually present with these alterations. In most causes, adults present with Philadelphia chromosome (Ph)-positive ALL, which is more aggressive.

In general, Douer states, 25% of adult patients and 50% of older adult patients diagnosed with ALL are Ph-positive. For these patients, the treatment primarily includes the use of BCR-ABL inhibitors, such as imatinib and nilotinib. When these treatments are utilized, it is sometimes possible to avoid transplantation, Douer states.