University of Chicago, Chicago, IL.
Stanford University, Stanford, CA.
JCO Oncol Pract. 2020 May;16(5):231-238. doi: 10.1200/JOP.19.00197. Epub 2020 Jan 29.
Adolescents and young adults (AYAs) with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL) represent a unique patient population with a disproportionate survival disadvantage compared with younger children. Substantial progress has been made as we began to understand and address the multifaceted drivers behind this outcome disparity. New insights into the biology of B-cell ALL have uncovered distinct genetic characteristics more commonly found in AYAs that affect prognosis. Dramatic improvements in survival have been achieved with the use of pediatric-inspired protocols in the front-line setting, as well as antibody-based and chimeric antigen receptor T-cell therapies in the relapsed and refractory setting. Guided by the incorporation of minimal residual disease testing to inform clinical decision making, these represent major paradigm shifts in management. Efforts to design clinical trials geared toward AYAs and to enroll AYAs in available clinical trials will ensure ongoing progress. Holistic care of AYAs with ALL further involves recognition of psychosocial issues arising as a consequence of their diagnosis and the delivery of age-appropriate supportive care.
费城染色体阴性急性淋巴细胞白血病（ALL）的青少年和年轻成人（AYAs）是一个独特的患者群体，与年幼的儿童相比，他们的生存劣势不成比例。随着我们开始理解和解决导致这种结果差异的多方面驱动因素，已经取得了重大进展。对 B 细胞 ALL 生物学的新见解揭示了在 AYAs 中更常见的、影响预后的独特遗传特征。在一线治疗中使用儿科启发的方案，以及在复发和难治性治疗中使用基于抗体和嵌合抗原受体 T 细胞疗法，已经实现了生存率的显著提高。通过将微小残留病检测纳入临床决策，这些代表了管理方面的重大范式转变。设计针对 AYAs 的临床试验并招募 AYAs 参加现有临床试验的努力将确保持续取得进展。对 ALL 的 AYAs 进行整体护理还需要认识到由于他们的诊断而产生的心理社会问题，并提供适合年龄的支持性护理。
