Ph-Negative Acute Lymphoblastic Leukemia in the Older Adults: Biology, Therapeutic Strategies and Unmet Needs - PubMed
4 hours ago
- #acute lymphoblastic leukemia
- #geriatric oncology
- #immunotherapy
- Ph-negative Acute Lymphoblastic Leukemia (ALL) in older adults presents significant challenges due to aging populations, adverse disease biology, and reduced tolerance to intensive chemotherapy.
- Pediatric-inspired regimens improve outcomes in younger adults but show poor survival rates in older patients, with high toxicity, early death, and relapse risks.
- Age-related comorbidities, impaired organ function, and unfavorable cytogenetic/molecular features like TP53 mutations worsen prognosis.
- Monoclonal antibodies (e.g., blinatumomab, inotuzumab ozogamicin) and CAR T-cell therapy offer promising frontline and relapsed/refractory treatment options with better tolerability.
- Challenges remain, including antigen loss, lineage switch, T-cell ALL management, and optimal immunotherapy sequencing.
- Comprehensive geriatric assessment is more predictive of treatment tolerability and outcomes than performance status alone.
- Tailored immunotherapeutic approaches and geriatric-focused treatment algorithms are key to improving long-term outcomes in older ALL patients.