Overview and Current News in Acute Lymphoblastic Leukemia

Abstract

The management of acute lymphoblastic leukemia is a challenge in patients of any age range. In the elderly patient, this challenge is further complicated by having to take into account the physical, social, psychological, and emotional factors of this age group, which, together with the complex nature of the disease’s biology, give rise to many questions. Although the diagnostic approach of the disease does not differ from that performed in pediatric or young patients, it does in the determination of risk factors and treatment, since many of the determinants of risk have a different value to that assigned in other patients, and, therefore, we cannot apply all available resources in younger patients to facilitate our work. The genetic alterations of ALL are found more frequently in elderly patients, since age is a factor that increases the risk of presenting these alterations. As an example, the prognostic value of the presence of Philadelphia chromosome (t (9:22)) cannot be weighted at the same scale as in pediatric patients. Comorbidities play another important role when it comes to making therapeutic decisions, and there is currently controversy regarding the use of scores designed to determine the physical and physiological status of elderly subjects. Several analyzes have been carried out to define the value and usefulness of these tools in the older patients with ALL; however, work must still be done in this area. The treatment schemes should be adjusted to the needs and specific characteristics of each individual in advanced age. The use of intensive chemotherapy should be discussed within a multidisciplinary team, always considering the benefit of our patients. In the present chapter, the diverse differences in ALL biology will be addressed when compared with those of children and young adults, and with the impact on the different prognostic determinants and their weight at the time of deciding treatment. The need to apply geriatric tools for decision-making and the therapeutic schemes used around the world for elderly people will also be discussed.