Acute Leukemias - Republican Scientific Medical Library

General Approach to the Therapy
of Adult Acute Lymphoblastic Leukemia
S.H. Faderl, H. M. Kantarjian
Contents
9.1 Introduction .................... 131
9.2 The General Treatment Outline of ALL 131
9.3 New Agents .................... 133
9.4 Conclusion ..................... 134
References ......................... 134
9.1 Introduction
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.
9.2 The General Treatment Outline of ALL
Most of the initial therapeutic advances in adult ALL
have arisen from successful adaptation of ALL treatment
strategies in children. ALL therapy incorporates
multiple drugs into regimen-specific sequences of dose
and time intensity and is divided into several phases: (i)
induction; (ii) a sequence of intensified consolidation;
(iii) a prolonged maintenance phase; and (iv) CNS prophylaxis
(Fig. 9.1). Intensive combination therapy in
ALL following this pattern has resulted in complete remission
(CR) rates of 80% to 90% and leukemia-free
survival rates of between 30% and 40% [1–4]. Various
groups in the USA and around the world are investigating
modifications of these treatment blocks in an effort
to improve upon the outcome. These strategies not only
Fig. 9.1. Basic principle of ALL therapy.