Management of acute lymphoblastic and acute myeloblastic leukemia in childhood

"Plus ça change, plus c'est la même chose." So it is murmured by skeptics who hear the blasts of premature trumpeting heralding early therapeutic triumphs, and then, years later, strain to hear the nearly inaudible notes of guarded optimism that report long-term evaluations. But life has changed, dramatically, for the child with leukemia. In the past untreated patients with acute lymphoblastic leukemia (ALL) or acute myeloblastic leukemia (AML) had a median survival of 1-3 months from the time of diagnosis. The most common causes of death were hemorrhage and infection. Today, the majority of properly treated children with ALL and AML remain continuously disease-free for over 5 and over 1 year, respectively. More than a third of children with ALL may be curable (1). The successful long-term management of children with leukemia often depends on appropriate decisions by the physicians who first encounter these patients. This review is intended to assist them.