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Biology and Treatment Paradigms in T Cell Acute Lymphoblastic Leukemia in Older Adolescents and Adults

  • Leukemia (PH Wiernik, Section Editor)
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Opinion statement

T cell acute lymphoblastic leukemia (T-ALL) occurs in approximately 25–30% of adult ALL diagnoses. Historically, B cell ALL (B-ALL) and T-ALL have been treated in the same fashion despite differences in the biology of disease. Outcomes in the adolescent/young adult (AYA) population have improved significantly with the utilization of pediatric-based regimens. In addition, there may now be a role for the addition of nelarabine to frontline treatment in the AYA population. In older adults, choices in which regimen to pursue should account for the potential toxicities associated with pediatric-based regimens. Measurable residual disease (MRD) has taken on increasing prognostic value in T-ALL and may help to identify which patients should receive an allogeneic stem cell transplant. T cell lymphoblastic lymphoma (T-LBL) has traditionally been treated similarly to T-ALL, but additional management questions must be considered. Mediastinal irradiation does not seem to clearly improve outcomes, and there is considerable heterogeneity in the central nervous system (CNS) prophylaxis strategy used in prospective trials. CNS prophylaxis in AYA patients with T-ALL, on the other hand, can be safely achieved with intrathecal chemotherapy alone. Prospective data regarding CNS prophylaxis strategies in older adults are currently not available. Nelarabine-based regimens currently remain the standard in relapsed/refractory T-ALL; however, novel therapies targeting molecular aberrations in T-ALL are actively being investigated.

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Authors and Affiliations

  1. Department of Medicine, Section of Hematology-Oncology, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 2115, Chicago, IL, 60637, USA

    Anand A. Patel MD & Wendy Stock MD

  2. Department of Medicine, University of Chicago, Chicago, IL, USA

    Joseph Thomas MD & Alexandra E. Rojek MD

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  1. Anand A. Patel MD
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  2. Joseph Thomas MD
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  3. Alexandra E. Rojek MD
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  4. Wendy Stock MD
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Correspondence to Wendy Stock MD.

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Anand A. Patel declares that he has no conflict of interest.

Joseph Thomas declares that he has no conflict of interest.

Alexandra E. Rojek declares that she has no conflict of interest.

Wendy Stock has received compensation from UpToDate, Research to Practice, Agios, Astellas, Daiichi, Kite, and Pfizer for service as a consultant.

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Patel, A.A., Thomas, J., Rojek, A.E. et al. Biology and Treatment Paradigms in T Cell Acute Lymphoblastic Leukemia in Older Adolescents and Adults. Curr. Treat. Options in Oncol. 21, 57 (2020). https://doi.org/10.1007/s11864-020-00757-5

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