Treatment of adult acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL) has served as a model for the cure of neoplasia by chemotherapy. Current treatment results in complete remissions in 80% to 90% of cases with long-term survival of 30% to 40%. Mature B cell and T cell ALL cases that previously had a poor prognosis are now viewed as favorable subgroups. Treatment regimens have evolved empirically into complex schemes, although few of the individual components have been rigorously tested in randomized trials. Maintenance therapy is a standard component of pediatric ALL, but its benefit has not been completely established in adults, although two trials which omitted maintenance are notable for short disease-free survival. Optimal consolidation and intensification therapy remains controversial with numerous trials suggesting benefit, but several randomized trials fail to confirm improved disease-free survival. Central nervous system prophylaxis is an integral step in treatment. Identification of subtypes of ALL with different prognosis and treatment requirements offers the potential to improve management and survival in ALL.