Treatment of acute leukemia in adults

The goal of therapy for young adults with de novo acute myeloid leukemia is cure. Seventy percent or more of young adults achieve initial remission, and 30% to 40% of adults receiving postremission chemotherapy appear to remain in remission. High-dose cytarabine consolidation therapy appears particularly effective. However, with current approaches, only 20% of young adults are cured. New approaches are needed to increase the cure rate substantially, and autologous bone marrow transplantation appears to be the most promising treatment modality in acute myeloid leukemia. Improved preparative regimens and purging techniques may be critical factors in determining the effectiveness of autologous bone marrow transplantation. In adult acute lymphoblastic leukemia, very high remission rates are now being reported with intensive multiagent induction therapy, and approximately one third of young adults with this disease are cured with current intensive chemotherapy approaches. The role and optimal methods of bone marrow transplantation for acute lymphoblastic leukemia are under investigation.