Developments in the treatment of acute leukemia in adults

Since 1977, when it was first demonstrated that a small number of patients with refractory leukemia could be cured by bone marrow transplantation, there has been an international effort to increase the proportion of patients cured. This article reviews recent developments in the treatment of adult leukemia with particular emphasis on reports published during the past year. Several new preparative regimens for transplantation are discussed. New chemotherapeutic strategies reported during the past year have included modulating the activity of cytarabine, the most active agent in autologous myelogenous leukemia, using other agents such as etoposide, mitoxantrone, and carboplatin, and attempting to overcome the multidrug resistance phenomenon. There has been further experience in the use of autologous marrow for transplantation, with several centers reporting excellent results for patients so treated. Biologic-based strategies are an exciting area of exploration. The implications of the landmark discovery of all-trans retinoic acid as a treatment for acute promyelocytic leukemia continue to be investigated. Reports of the use of targeted monoclonal antibodies, cytokines, and other immunotherapies have generated the hope that these strategies might prove to be non-cross-resistant therapies and thus effective against residual disease following conventional chemotherapy.