Table of Contents Table of Contents
Previous Page  30 / 94 Next Page
Information
Show Menu
Previous Page 30 / 94 Next Page
Page Background

28

NCCN Guidelines for Patients

®

:

Acute Lymphoblastic Leukemia, Version 1.2017

3

Treatment planning

Age issues in ALL

The two main cytogenetic subtypes that doctors use

for treatment planning are described next.

†

†

Ph-positive ALL

– In this subtype of ALL,

the leukemia cells have the Philadelphia

chromosome. This is the most common

cytogenetic subtype in adults with ALL. It is

rare in children. The chance of having this

cytogenetic subtype increases with age.

Among adults with ALL, about 25 out of 100

have Ph-positive ALL. Among children with ALL,

about 3 out of 100 have this subtype.

†

†

Ph-negative ALL

– In this subtype of ALL, the

leukemia cells do not have the Philadelphia

chromosome. This cytogenetic subtype is more

common in children than in adults. Among

adults with ALL, about 75 out of 100 have Ph-

negative ALL. Among children with ALL, more

than 95 out of 100 have this subtype.

Age issues in ALL

A person’s age at the time ALL is diagnosed is one

of the most important factors that doctors use to

plan treatment. As a result, recommendations in the

Treatment guide are divided into two age groups:

†

†

AYA (

a

dolescent and

y

oung

a

dult) patients who

are 15 to 39 years of age

†

†

Older adult patients who are 40 years of age or

older

AYAs and older adults differ in many ways. These

differences carry over into personal, social,

emotional, and medical needs. There are also key

differences between AYAs and older adults with ALL

that doctors must consider when making treatment

decisions. In particular, AYAs have much better

outcomes when given more intensive ALL treatments

like those designed for children.

Intense treatments can cause serious side effects

that get harder to tolerate with age. Because AYAs

are usually able to tolerate the intensive treatments,

they benefit greatly and have much better treatment

results. The side effects of intensive treatments tend

to be more severe and harder to recover from for

older patients.

Generally, doctors use the age of 65 as the cut-off for

intensive treatments. This is because older patients

may not be able to tolerate them. But, age alone

is not a good gauge for deciding if a person can

tolerate these treatments.

A person older than 65 may be still in good health

overall and not have other serious health problems.

In this case, he or she may still benefit from more

intensive treatments. Likewise, a person younger

than 65 may be in poorer health overall and have

other serious health problems. In this case, he or she

may not be able to tolerate intensive treatments.

Thus, doctors must also consider your overall health

as well as your age. Assessing your overall health,

fitness, and other current health problems is very

important. This includes checking how well organs

such as your heart, lungs, liver, and kidneys are

working.

About AYAs

AYAs have a unique set of needs and challenges that

differ greatly from those of young children and older

adults.

Discussing all of these important aspects is beyond

the scope of this book. More details and information

focused on AYAs with cancer can be found in the

NCCN Guidelines for Patients®: Adolescents and

Young Adults with Cancer

. These guidelines are

available for free at

www.nccn.org/patients

.