Improved survival in adult acute lymphoblastic leukemia. Need for more effective CNS prophylaxis

Using a multimodality approach to adult acute lymphoblastic leukemia, 93% of patients achieved a complete remission; among patients achieving a complete remission, 43% are predicted to remain disease-free for 5 years. Despite use of cranial irradiation (2400 rad) and intrathecal methotrexate (12 mg X 5), CNS relapse occurred in 5/14 patients (36%). With improved systemic therapy of adult ALL, survival is increased and "standard" CNS prophylaxis is not as effective as it appeared to be when systemic remissions were of shorter duration. More effective approaches to CNS prophylaxis need to be devised.