Optimal management of adults with ALL

The cure rate of acute lymphoblastic leukaemia (ALL) in adults remains unsatisfactory. The remarkable progress in childhood ALL has not been replicated in adult ALL and approximately two thirds of patients younger than 60 years, and more than 90% of those over 60 years, are expected to succumb to their disease. Over 80% of adults can achieve a complete remission; however, the majority of such patients relapse. Nevertheless, significant developments have occurred over the past decade. Prognostic factors have been more clearly defined, moving cytogenetics and molecular determinants forefront, much like acute myeloid leukaemia. Studies of postremission therapy have included prospective evaluation of allogeneic transplantation in areas not previously evaluated, i.e. patients with standard risk. Most importantly, the advent of imatinib mesylate has changed the outlook for adults with Ph-positive ALL. Much work needs to be done to further improve chemotherapy treatment and reduce the toxicity of transplants.