Marlise Luskin, MD, MSCE, a leukemia specialist at Dana-Farber Cancer Institute describes treatment for adults with acute lymphoblastic leukemia (ALL). She explains treatment considerations for younger adults and older adults with ALL. For more information about our Adult Leukemia Program, visit
https://www.dana-farber.org/adult-leukemia-program/ My name is Marlys Luskin. I'm a physician in the adult leukemia group at Dana Farber Cancer Institute and I specialize in the care of patients with leukemia, including acute lymphoblastic leukemia. A. L. L. Is a challenging diagnosis because it's not common. It's a it's a relatively rare disease, but it's an aggressive disease. So I made a page with A. L. L. I really try to tailor their their therapy, their treatment recommendation based on their particular situation. And so I consider both factors related to the patient, what their ages, what medical problems they have, what their goals and uh and families situation might be. And then I consider characteristics related to the disease is that their first treatment that they're trying to determine what the best start might be or they here to try something different because a previous treatment hasn't been as successful as they hoped. And then all the characteristics of the disease, including what subtype, including whether they have B. Cell or T. Cell A. L. L. And whether they have particular genetic abnormalities like the philadelphia chromosome that might alter the treatment for their disease. We recognize that all of our patients are unique and they have unique needs based on their age, patients who are younger have unique, unique needs because of their stage in life. There there young uh they're often have challenges related to work in school. And so we collaborate with our young adult program for those patients. Then similarly our patients who are older have other challenges related to their mobility or cognition or frailty. And we're lucky to have jerry attrition to specialize in the care of older adults embedded at Dana Farber that we're able to collaborate with to make sure that we're optimally managing side effects and other medical problems to allow us to continue treatment of the leukemia. Historically, the regiments for young adults and older adults involved a lot of the same types of chemotherapy, but there were important differences. The regiments for Children have been very focused on particular types of chemotherapy, including steroids and Christine and a drug called Despair Dennis. So the interest in applying to pediatric style regiments to younger adults began about 20 years ago when various groups in the United States and Europe recognized that uh, that young adults who were treated at pediatric centers had improved outcomes than those treated at adult centers. And that sort of inspired various efforts to perspectively apply these pediatric regiments to young adults and demonstrate that they were tolerable and safe and had had good outcomes. And Dana Farber is one of the places where we, where we did that these regiments are intensive and they're complicated and we really leaned on our colleagues across the street and brought their experience and their regimens developed at the jimmy fund to our adolescents and young adults and we found that our young adults could tolerate this regimen and they had good outcomes when they received it. But on the converse, we know those drugs are not well tolerated older adults and they have a lot of toxicity and when they have too many side effects are unable to complete treatment and they don't do as well. And we know that the success of those treatments are not as good as as as they are in younger patients. So we've really been looking for new approaches for older adults with a wall and we've been able to take advantage of new drugs that have been more recently approved for Relapse DLL that have unique mechanisms action are highly effective and have different side effects. And so our approach right now is to participate in ongoing clinical trials and investigations to bring these novel agents earlier in treatment including into the first line setting with for older adults and decrease the amount of intensive chemotherapy with the goal of improving both outcomes and response rates as well as decreasing side effects of treatment. And we're lucky to have a lot of lot of promising drugs for A. L. L. Right now. And what we need is to be able to take the science forward and take medicine forward um and learn which treatments are the best for patients. And we think that this advances the care of the individual patient who has access to the best treatments available and also helps us take care of all patients as we learn more about the disease. Mhm.