[Adult acute lymphoblastic leukemia]

The diagnosis of adult acute lymphoblastic leukemia (ALL) and the recognition of immuno-genetic entities according to the WHO classification require a comprehensive clinical and biological work-up. The diagnosis of Burkitt mature B-cell ALL is an emergency, since intensive chemotherapy and tumour lysis syndrome prevention lead to an 80% cure rate. Within one week, distinction must be established between B-cell Philadelphia chromosome-positive (Ph+) ALL on one side, Philadelphia-negative B-cell ALL and T cell ALL on the other. The once severe Ph+ ALL now displays a 70% long-term survival rate when treated by associations of chemotherapy and targeted therapy by tyrosine-kinase inhibitors. In Ph-negative ALL, identification of new relapse risk factors, mostly minimal residual disease, justifies to revisit the indications for allogeneic hematopoietic stem cell transplantation, in comparison to pediatric-inspired chemotherapy regimens, with the goal of curing 60% of the patients. However, the outcome of patients above the age of 60 remains dismal.