TREATMENT OF CHILDHOOD AND ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA

In the last 30 years the treatment of acute lymphoblastic leukaemia ha s radically changed and intensified and has resulted in improvements i n the chances of cure in children to up to 70% but in adults only 30% will achieve long-term disease-free survival. Data from large therapeu tic trials have determined good and poor prognostic risk factors which have been of use in planning risk-directed treatment protocols and ca n influence the chance of cure. However intensification of treatment h as also been associated with increased toxicity and significant late e ffects, particularly in children. In the future it will be necessary f or more international collaboration and a more uniform approach to tre atment in order to achieve continued improvements in the survival from this disease. In children it will be necessary to focus efforts on im proving treatment of relapsed patients: chemotherapy protocols in thos e with a first remission of >36 months, or for the high-risk patients with a shorter first remission, new transplantation approaches directe d towards enhancing the graft-versus-leukaemia effect are going to be df increasing importance. In adults, continued efforts will be directe d towards improving first remission rates with the use of increasingly intensive chemotherapeutic protocols and growth factors. The use of u nrelated donor transplantation is also likely to increase, particularl y in patients with 'poor-risk' disease.