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Adolescents and young adults with hematological disorders: Challenges and perspectives
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This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.
Adolescents and young adults (AYA) with haematological disorders meet unique challenges especially in case of cancer diagnosis and management. The desire to be treated like an adult or, in case of young adults, the idea that they are too old to be treated in a paediatric institution may influence where AYA patients seek care. This book addresses the needs of AYA patients who face special therapeutic challenges with a focus on haematological disorders. It comprises of 18 chapters and aims to increase awareness of this group of patients. It covers a wide spectrum of haematological disorders that are pertinent to AYA patients with up-to-date and well written chapters.
In the chapter, “Acute Lymphoblastic Leukemia in Adolescents and Young Adults”, the authors have quoted the defining age from established groups with explanation. A detailed account of the difference between AYA and paediatric cases with respect to mutations has been given. A comprehensive comparison with paediatric ALL with respect to the treatment has also been highlighted, along with retrospective comparisons of AYA ALL patients treated by adult versus paediatric oncologists. Although incidence of negative pH in paediatric ALL is mentioned, the same in case of AYA is not mentioned, despite the fact that work up for it in AYA is suggested. Also the role of hematopoietic stem cell transplantation (HSCT) in AYA has not been elaborated. The role of newer agents like moxetumomab, inotuzumab, blinatumomab, and CAR (chimeric antigen receptor) in AYA has also not been mentioned.
In the next chapter, “The Challenging Aspects of Managing Adolescents and Young Adults with Hodgkin's Lymphoma”, there is an extensive comparison of the prognosis of the same protocol between young adults and adolescents. Emphasis has been laid on the effects of anthracycline therapy on adolescents. In the chapter, “Adolescents and Young Adults with Non-Hodgkin's Lymphoma: Slipping between the Cracks”, the common non-hodgkin lymphomas (NHLs) are discussed accordingly for AYAs citing relevant studies. In another chapter, “Acute Myeloid Leukemia in Adolescents and Young Adults: Challenging Aspects”, a due consideration of various psychological aspects and quality of life (fertility, issues concerning siblings of AYA) has been taken into account, while in “Chronic Myeloid Leukemia in Adolescents and Young Adults: Patient Characteristics, Outcomes and Review of the Literature”, an extensive justification of apparent discrepancies across studies comparing the outcome of AYA CML patients is available. Issues of adherence to oral tyrosine-kinase inhibitors (TKIs), impact of cost of care, insurance and access to healthcare have been dealt with.
In the chapter, “Acute Promyelocytic Leukemia in Children and Adolescents”, toxicity of all trans retinoic acid (ATRA) and chemotherapy has been emphasized. In the next chapter, “Hematopoietic Stem Cell Transplantation in Adolescents and Young Adults”, issues like fertility and after late effects which are important issues in this age group have been duly considered.
The chapter, “Challenging Aspects of Managing Hemostasis in Adolescents”, provides information on some common acquired causes of Venous thromboembolism (VTE), but the approach to diagnosis and management of VTE and the rationale of treatment have not been elaborated. However, emphasis on menorrhagia, one of the important causes of blood loss in adolescents has been given priority, but important topics such as haemophilia A and the development of inhibitors have not been touched upon.
In the chapter, “Aplastic Anemia in Adolescents and Young Adults”, thorough diagnostic work up has been elaborated. The issues of delayed presentation has been dealt with, similarly importance to differentiate aplastic anaemia from pancytopenia is emphasized. Social issues (insurance, education, employment) and family issues (pregnancy, fertility) have also been given importance. In the chapter, “Thalassemia Major and Sickle Cell Disease in Adolescents and Young Adults”, risk factors for acute coronary syndrome are described. Also the role of hydroxyurea on sperm count is quoted appropriately with studies. Issues of family counselling for haemoglobinopathy and sickle cell disease have not been discussed. The effects of hyperferritinaemia on heart have not been discussed. Premarital counselling should have also been included in this target age group. Issues such as adherence, survivorship, cardiotoxicity in childhood cancer and challenges in cancer care delivery in AYA patients have also been discussed.
This book is likely to be relevant for basic researchers, healthcare professionals who are inclined to learn more about haematological manifestations in AYA. It may also be of interest to physicians dealing with AYA, especially in the field of haematology and oncology, as well as paramedical staff including nurses, psychologists, social workers and pharmacists.
