[Current aspects of therapy in chronic and acute leukemias]

A significant fraction of patients with chronic myelogenous leukemia (CML) in the chronic phase have durable hematologic remissions following treatment with interferon-alpha. Some clinical trials are beginning to show a modest overall survival advantage with interferon compared to hydroxyurea. The only curative therapy for CML is allogeneic bone marrow transplantation. In chronic lymphocytic leukemia (CLL), stable early stage disease requires no treatment. Recent trials have confirmed that several new purine analogues are effective in CLL. In acute myeloid leukemias there appears to be a dose-dependent effect on remission and intensified treatment may increase the percentage of disease free survivors. Hemopoietic growth factors may reduce treatment-related morbidity and mortality. Enhancement of cytotoxicity by prestimulation with GM-CSF is still controversial. All-trans retinoic acid induces remissions in 80% of patients with acute promyelocytic leukemia by forcing the leukemic promyelocytes to maturation. Allogeneic bone marrow transplantation is effective in high risk patients with Philadelphia chromosome positive acute lymphocytic leukemia (ALL), in patients with relapse or resistant acute myelogenous leukemia (AML) or ALL. In patients with ALL a risk-adapted therapy including allogeneic and autologous bone marrow transplantation and the use of hemopoietic growth factors to improve supportive therapy may result in more cures.