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ISAL 2025 | The unique challenges for young adults with ALL
Wendy Stock, MD, University of Chicago Medical Centre, Chicago, IL, comments on the unique challenges for young adults with acute lymphoblastic leukemia (ALL). She highlights the need for adapted treatment regimens due to toxicities and emphasizes the importance of providing psychological support and job retraining to ensure a good quality of life during and after treatment. This interview took place at the 19th International Symposium on Acute Leukemias (ISAL XIX) in Munich, Germany.
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Transcript
The young adult population has some unique challenges, many unique challenges, in the sense that the young adult doesn’t really fit into the pediatric category anymore, although we have learned that treatment using a pediatric regimen dramatically improves disease-free and overall survival in that patient population. So one of the challenges has been to learn how to adapt and adopt and manage these kind of regimens in a young adult population...
The young adult population has some unique challenges, many unique challenges, in the sense that the young adult doesn’t really fit into the pediatric category anymore, although we have learned that treatment using a pediatric regimen dramatically improves disease-free and overall survival in that patient population. So one of the challenges has been to learn how to adapt and adopt and manage these kind of regimens in a young adult population. So the toxicities are much greater. And the particular toxicities that these pediatric regimens utilize, the particular agents that are really intensified include glucocorticoids, vincristine, and asparaginase, all of which have much more dramatic toxicity profile in a young adult population. So there’s that. And that’s very important since we’re thinking about long-term survival and we want to have good quality and quantity of life. So in addition, the young adult faces unique psychosocial challenges. They are much likelier to feel isolated from their peer group. Often their lives are very disrupted because they’re just in the middle of finding themselves as a young adult, college education, early career, professional training, etc. And so there’s a lot of intensity emotionally for these patients, just like there is for any patient, but the young adult finds themselves in a unique situation, also with regards to long-term relationships, sexuality, fertility. All of these things need to be addressed in a very focused manner to allow patients to have good quality of life during and, most importantly, after treatment. And so psychological, physical therapy support, job retraining sometimes is really an important consideration that we don’t often have support for in our clinics or referral centers for that kind of thing. So those are all of the issues that are somewhat unique to this population and also result in decreased adherence to the treatment regimens because of the challenges that are imposed on these people, many of whom do not yet have a structured life environment without good partnership. They’re no longer with their parents necessarily, and they don’t have yet many of them long-term relationships or partners that can help them through these arduous long treatments. So it’s a really unique population that requires special support.
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