THE USE OF ANTHRACYCLINES IN ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA

A critical review of the role of anthracyclines in the management of a dult patients with acute lymphoblastic leukemia was performed to defin e current indications for their use. Major pertinent clinical series w ere reviewed with reference to anthracycline type, cumulative dosage a nd dose intensity, and administration schedule during both induction t herapy and postremission consolidation, comparing results, whenever po ssible, with non-anthracycline treatment groups. A subgroup analysis w as performed to evidentiate disease subtypes likely associated with a favorable outcome to anthracycline treatment. The results indicated th at anthracydines may still play a primary role in this setting. In par ticular, anthracyclines should be used at full therapeutic doses, espe cially during induction and early consolidation; idarubicin could be a better choice than daunorubicin or adriamycin; finally, an early brie f intensive treatment with anthracyclines may provide an excellent pro bability of long-term disease-free survival in CD10(+) t(9;22)-negativ e B-precursor adult ALL, obviating the need for prolonged maintenance or late reinduction therapy.