Figure 1.

Prognosis to treatment relationships in AYA Ph– ALL. Different patient characteristics and clinicobiologic ALL subsets concur to determine the individual risk profile. Postinduction MRD analysis reflects patterns of chemosensitivity and refines the prognostic index, which is used to orientate postremission therapy reserving an allogeneic HCT to HR patients (see also Table 2 and Figure 2). MRD itself can be targeted with novel immunotherapeutics and other experimental agents (i.e. blinatumomab in CD19+ ALL, CAR-T cells, etc.). Regardless of risk class definition and transplantation policy (a decision related to specific protocol design), overall patient outcome is improved using pediatric-based rather than traditional adult chemotherapy protocols.

ALL, acute lymphoblastic leukemia; AYA, adolescents and young adults; HCT, hematopoietic cell transplantation; HR, high risk; MRD, minimal (or measurable) residual disease; Ph–, Philadelphia chromosome-negative B-ALL.