Acute Lymphoblastic Leukemia: The Young, The Old, and How Little is Too Much

Mark G. Frattini, MD, PhD

2010-12-04

We have all heard the age-old argument that more is better. Well today in regard to patients with acute lymphoblastic leukemia (ALL), whether young or old, the question is, “Is less more?”.

This morning at 9:30 a.m. and again at 2:00 p.m. in Valencia B/C, Dr. David Marks of the University Hospitals Bristol NHS Foundation Trust in the United Kingdom will chair a session outlining the current strategies on how expert       clinicians manage both younger and older adults with ALL.  The session will detail recent clinical trials for both age groups, differences in biology between young and old, and finally the use of minimal residual disease (MRD) testing in guiding therapeutic decisions.

Dr. Wendy Stock from the University of Chicago will open the session with a focus on the younger patient with ALL (up to age 30). She will describe the current management and clinical trials for this group of patients. This will include delineation of the biological/sociological differences between these patients and older adults with this disease.

Dr. David Marks will then discuss the treatment of older adults with ALL. In addition to outlining each phase of therapy, he will detail the prognostic factors and the role of both autologous and allogeneic stem cell transplantation in the clinical management of this group of patients. There will also be a discussion of both T-cell ALL and relapsed disease as well as a glimpse at possible future therapeutic options for these patients.

Finally, Dr. Dario Campana from St. Jude Children’s Research Hospital will describe the use of MRD detection strategies in patients with ALL and its clinical significance in both children and adults. Dr. Campana will outline both the rationale and specific methods for MRD monitoring in patients with ALL and correlate the treatment response determined by MRD analysis with the genetic and biological characteristics of the disease.

For now, it seems indeed that less is more. The challenge will be to implement these strategies into the treatment of all patients with ALL in order to improve the disease-free and overall survival.  

Dr. Frattini indicated no relevant conflicts of interest.