Newman Haley, Hunger Stephen P
Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA.
Division of Oncology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
J Clin Oncol. 2024 Feb 20;42(6):665-674. doi: 10.1200/JCO.23.01351. Epub 2023 Oct 27.
Over the past several decades, survival of children with ALL has improved dramatically with treatment regimens refined through cooperative group trials. Despite aggressive treatment and iterative therapy changes for adolescents and young adults (AYAs), improvement has not been as promising. Comparisons between pediatric and adult clinical trials have consistently demonstrated superior outcomes for AYAs treated on pediatric ALL protocols, leading to the implementation of pediatric-inspired ALL protocols by several groups worldwide and/or expansion of the age limit of pediatric trials to include the full spectrum of the AYA population. Despite these efforts, AYAs in both pediatric and adult settings continue to have inferior survival compared with younger children with ALL. Real-world data suggest that uptake of pediatric-style treatment is variable, and even with identical pediatric-style treatment, AYAs still fare worse than younger children. As we enter an era of immunotherapy and precision medicine for newly diagnosed ALL, now is an opportune time to consider how best to approach future therapy for AYA patients. Comparisons of pediatric and adult treatment approaches and subanalyses of AYA patients will help guide harmonization of treatment. The focus of the next stage of ALL therapy for AYA should not only involve novel treatment approaches but also standardization and optimization of supportive care measures, psychosocial support, adherence interventions, oncofertility treatment, and survivorship care. All these efforts should simultaneously work to address health disparities to ensure that a future of improved outcomes is experienced equitably for all AYA patients.
在过去几十年中，通过合作组试验优化治疗方案，急性淋巴细胞白血病（ALL）患儿的生存率有了显著提高。尽管对青少年和年轻成人（AYA）采取了积极的治疗措施并不断改进治疗方案，但改善效果并不理想。儿科和成人临床试验的比较一致表明，接受儿科ALL方案治疗的AYA患者的预后更好，这导致全球多个研究组采用受儿科启发的ALL方案和/或将儿科试验的年龄限制扩大至涵盖整个AYA人群。尽管做出了这些努力，但与患ALL的年幼儿童相比，儿科和成人环境中的AYA患者生存率仍然较低。真实世界的数据表明，儿科式治疗的采用情况各不相同，即使采用相同的儿科式治疗，AYA患者的情况仍比年幼儿童更差。随着我们进入新诊断ALL的免疫治疗和精准医学时代，现在是考虑如何为AYA患者提供最佳未来治疗方案的适当时机。比较儿科和成人的治疗方法以及对AYA患者进行亚组分析将有助于指导治疗的统一。ALL治疗AYA的下一阶段重点不仅应包括新的治疗方法，还应包括支持性护理措施、心理社会支持、依从性干预、生育力保护治疗和生存护理的标准化和优化。所有这些努力应同时致力于解决健康差异问题，以确保所有AYA患者都能公平地体验到改善后的预后。
