General Approach to the Therapy of Adult Acute Lymphoblastic Leukemia

Remarkable progress has been made in the treatment and outcome of adult acute lymphoblastic leukemia (ALL) over the past 3 decades. This progress is the result of an accumulation of a mosaic of knowledge and experience, which have led to a more profound understanding of the biology of the disease, and at the same time the development of new drugs and treatment strategies. Advances in the understanding of the biology has highlighted significant differences between childhood and adult ALL (e.g., high frequency of Philadelphia-positive ALL and low incidence of TEL-AML1-positive disease in adults) and thus explains at least partly the divergence of outcomes that is still observed between children and adults. Moreover, ALL is increasingly recognized as a group of heterogeneous disease entities with unique responses to therapy and prognosis. The combination of further cytogenetic-molecular dissection of ALL subtypes with the emergence of new and targeted therapies will thus continue to constitute the fundament upon which further progress will hopefully occur in adult ALL.