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from Section 3 - Evaluation and treatment
Published online by Cambridge University Press: 05 April 2013
Introduction
Outcome for young adult patients with acute lymphoblastic leukemia (ALL) is inferior to that of children aged 10 to 14 years and particularly those aged 1 to 9 years at diagnosis. For patients 15 to 24 years of age at diagnosis, 5-year survival has increased steadily from 36.2% in the 1980s to 55.7% in the 1990s. However, there has been no improvement in outcome for patients treated between 2000 and 2005.
Adolescents with ALL are a unique group in that treatment may be provided by either medical or pediatric oncologists. Referral to an oncologist is generally based on the preference of the primary care provider: internists and family practice physicians generally refer patients to medical oncologists while pediatricians refer patients to pediatric oncologists. Adults with ALL have a worse outcome compared with children. The reasons for a worse outcome in adult patients with ALL include a lower incidence of favorable genetic subtypes (t(12;21) or hyperdiploidy), a higher incidence of t(9;22), the presence of comorbidities in older adults, and greater treatment-associated morbidity and mortality. Avascular necrosis of bone is a significant complication of therapy that occurs almost exclusively in adolescents and young adults. There is also a significantly lower salvage rate for older patients who experience a relapse compared with younger patients.
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