Treatment Of Acute Lymphoblastic Leukemia In Middle-Age And Older Adults

For adults with newly diagnosed acute lymphoblastic leukemia (ALL), careful diagnostic studies are essential for risk stratification. The goal of treatment is to achieve complete remission (CR) quickly to restore normal hematopoiesis and avoid the emergence of resistant subclones, to adequately prophylax sanctuary sites, and then to maintain remission through the use of consolidation and maintenance therapies to eliminate minimal residual disease. Current remission induction programs typically include vincristine, a corticosteroid, and an anthracycline often with various other agents, and achieve CR in 70–80% of middle-aged patients with unfavorable cytogenetics and >90% of those with a normal karyotype or T-ALL. Commonly used standard regimens will be discussed in this chapter, including the use of hematopoietic stem cell transplantation in CR1. While there has been increasing success in treating younger and middle-aged adults with ALL, older adults present major challenges in treatment. We discuss the available data that exist on ALL in this population as well as some novel agents that are being studied.