Adolescents and young adults (AYAs) vs pediatric patients: survival, risks, and barriers to enrollment

Adolescents and young adults (AYAs; ages 15 - 39 years) with acute lym pho blas tic leu ke mia (ALL) have worse out comes than pedi at ric patients with ALL. Multiple fac tors con trib ute to this dif fer en tial sur vival. AYAs are more likely to have higher- risk leu ke mia biol ogy than chil dren with ALL. AYA patients have more choices for treat ment facil ity and treatment pro to col, as well as bar ri ers to clin i cal trial enroll ment, both of which can affect sur vival. AYAs must also nav i gate psy cho so cial fac tors inher ent to their unique devel op men tal stage. Furthermore, AYAs typ i cally sus tain more treatment-related toxicities than pediatric patients. Treatment on pediatric or pediatric-inspired ALL protocols at pediatric can cer cen ters has been asso ci ated with improved out comes for AYAs with ALL, but there is still var i a tion in the treatment that AYAs with ALL receive. Clinical trials focused on AYAs with ALL and individualized decision-making regarding choice of treat ment facil ity and treat ment pro to col are needed to opti mize the sur vival and long- term out comes of this patient population.