[Treatment of acute leukemia]

Evaluations of 650 patients with acute lymphoblastic leukemias (A.L.L.) and of 596 patients with acute granulocytic leukemias (A.G.L.) ara analyzed. The patients were treated in the department of Professeur Jean Bernard at Saint-Louis Hospital between 1964 and 1976. In A.L.L., prognosis is influenced primarely by age, being worse in infants less than 1 year old and in adults: it is also influenced by the blastic load and by other parameters such as cytology and immunological markers which could not be studied in all patients. The correlation between high blastic load and the T lymphoblasts variety is noteworthy. Random studies are still necessary to find out the best drug combinations and the optimal duration of treatment, but the necessity for meningeal prophylaxis, reinduction treatments and of L-A sparaginase consolidation is no longer discussed. Prognostic stratification is useful for therapeutical evaluation and should load to therapeutical modulation. In acute granulocytic leukemias, age is also a significant parameter and remission rate is lower for patients over 50 years of age. Cytology and cytochemistry allow to recognize acute promyelocytic leukemias and acute monoblastic leukemias which bear specific initial risks (D.I.C. for A.P.L., renal failure for acute monoblastic leukemia) but which are highly sensitive to Daunorubicin and Rubidazone respectively. In A.M.L. remission duration is not influenced by age and seems to be improved by intermittent treatment. The role of immunotherapy is still under study.