Acute Lymphoblastic Leukemia in Adolescent & Young Adult Populations and Adherence to Protocol: A Case Study

Adolescent and young adult (AYA) populations treated for acute lymphoblastic leukemia (ALL) have worse outcomes compared to pediatric patients. In addition, the AYA population has an increased rate of non-adherence to treatment, particularly in the maintenance therapy phase. Case Report: The case is that of a 19 year old male who was diagnosed with Philadelphia chromosome-positive B-cell ALL. He was managed at an adult cancer center and started on the Hyper-CVAD treatment protocol plus Tyrosine Kinase Inhibitor (TKI) and achieved complete remission. All of his subsequent treatment cycles were delayed for up to fifteen days due to difficulties with compliance and timely follow-up. The patient expressed frustration with prolonged hospital stays and ultimately left the treatment center against medical advice, failing to complete the intensive protocol. Anticipating a poor prognosis for long term remission, the patient was referred for bone marrow transplant; he had variable compliance with follow-up and oral TKI. Approximately 15 months after initial diagnosis, he presented in a state of leukemic relapse. He was transferred to a pediatric leukemia center for intensive relapse therapy but died due to infectious complications. This case illustrates the unique challenges faced when treating AYA leukemia patients and that failure of compliance may adversely impact outcomes. Further research into these unique factors is warranted in order to improve protocol adherence and thereby treatment in AYA populations.