Table 1.
Main differences between pediatric-based and adult-type programs for Ph– ALL in AYA patients.
| Treatment phase | Characteristics of pediatric-based therapy (versus adult standard therapy) | Annotations |
|---|---|---|
| Chemotherapy (induction, consolidation, maintenance) | Corticosteroids: higher cumulative dose | Dexamethasone preferred (higher activity); Higher penetration into CNS; Toxicity: osteonecrosis (age-related), other [metabolism, hypertension, peptic ulcer, infections (fungal)] |
| Vincristine: higher injection no. and cumulative dose | Risk of neuropathy (higher doses) | |
| Asparaginase/Peg-ASP: higher cumulative dose | Peg-ASP recommended/preferred (minimum 4
injections); Careful association with other potentially hepatotoxic drugs; Toxicity (risk factors: age >45, liver steatosis, BMI >30): hepatic, metabolic, pancreatic coagulation/thrombosis, allergy |
|
| Antimetabolites: more intensive use and higher cumulative dose of MTX, 6-thiopurines, cytarabine | Higher MTX dose recommended/preferred (>1.5 g/m2, up to 3–5 g/m2) | |
| Anthracyclines: less intensive use | Lower risk of myelotoxicity and cardiomyopathy | |
| CNS prophylaxis | IT chemotherapy: intensified, higher injection no. | Single agent IT MTX, cytarabine or triple IT combination (MTX, cytarabine, corticosteroids) |
| Cranial prophylaxis: omitted or in high-risk subsets only | Higher activity of systemic CNS-active therapy and IT
prophylaxis; Better treatment compliance, lower risk of short- and long-term brain damage; Radiation-related risk of secondary brain neoplasms |
|
| Treatment intensity/adherence | Aim: higher overall intensity without undue dose reductions and treatment delay | Dedicated, well-trained staff (medical and
nonmedical); Compliance to intensive chemotherapy |
| Allogeneic HCT | First CR: according to MRD/risk-based strategy | More frequently used in AYA/adults (>15–18 years) compared with children |
| Salvage: standard procedure in second/later CR | – |
ALL, acute lymphoblastic leukemia; AYA, adolescents and young adults; BMI, body mass index; CNS, central nervous system; CR, complete remission; HCT, hematopoietic cell transplantation; IT, intrathecal; MRD, minimal residual disease; MTX, methotrexate; Peg-ASP, pegylated asparaginase; Ph–, Philadelphia chromosome-negative B-ALL.