What's the Difference Between Pediatric and Adult ALL?

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Esther Schorr:

Hi there.  This is Esther Schorr from Patient Power.  I'm here at ASH 2019, and as you can see in the background there are like 25,000 hematologists, oncologists, researchers here talking about the latest in treatment for various hematological conditions. 

I'm here today with Dr. Shira Dinner, who has lots of expertise related to ALL.  She is from Northwestern University. 

Dr. Dinner:

Yes, that's correct. 

Esther Schorr:

So, Dr. Dinner, maybe we could start by talking a little bit about ALL and some of the things that you've been working on that have to do with the evolving treatments for ALL, and I know that our audience would be interested in differences between pediatric treatment and perhaps adults who are diagnosed with acute lymphocytic leukemia. 

Dr. Dinner:

Of course.  So more commonly acute lymphoblastic leukemia is diagnosed in children, and often they will receive more intensive chemotherapy regimens and tend to have more favorable survival outcomes.  However, we are learning, especially looking at adolescents and some young adults with ALL, so patients between the ages of approximately 15 and 39 or 18 and 39 depending on how you're defining it, they can be treated with pediatric‑inspired intensive chemotherapy regimens, and this is improving their survival outcomes. 

So this is where we're going in terms of the recommended standards for treating patients.  Recently, within the last year, Wendy Stock published in Blood the results of the CLGB 10403 trial which specifically looked at a pediatric‑inspired chemo regimen in an adolescent and young adult population, and those patients did have improve survival outcomes. 

Esther Schorr:

So what's the implication there?  So you have this middle group that are not young children, they're adolescents, young adults, how will that change their experience of treatment? 

Dr. Dinner:

Well, it's a difficult group to deal with in general.  It's a very difficult time of life to have to be faced with such as adverse event.  They are just on the cusp of becoming very independent from their families, perhaps financial independence, social independence, and then to have that taken all away from them by having such a horrible diagnosis is very difficult. 

There also seems to be something biologically different about their disease.  They don't tend to do as well as young children will.  And we are learning about certain subsets of ALL called Ph‑like ALL that has certain gene mutations that seem to indicate that they do have a greater resistance to chemotherapy, and it seems more prevalent in this adolescent and young adult population than in children, so we are trying to use the intensified chemotherapy regimens for them.  However, I think we still need to improve upon that. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.