Adult acute leukemia. Aggressive treatment improves survival.

Although improvements in the management of adults with acute leukemia have lagged behind those seen in the treatment of children, there are clear reasons for optimism. Combination chemotherapy for acute myeloblastic leukemia (AML) and acute lymphoblastic leukemia (ALL) in adults results in complete remissions in 50-85% of patients. An increasing number of these patients remain in continuous remission for over two years with a significant proportion (15-25%) disease-free after five years. Those who remain in remission for more than five years have a low incidence of relapse and many may be cured. Nevertheless, there are still many problems to be solved. Improved, less toxic induction regimens are needed. The roles of maintenance, late intensification, and central nervous system prophylaxis remain unresolved. The results of bone marrow transplantation for adults with AML in remission are encouraging enough to make this an attractive form of therapy for any patient younger than age 40 with a histocompatible sibling. New forms of treatment, such as immunotherapy and monoclonal antibodies, remain investigational.