Intensive chemotherapy for Philadelphia-chromosome-positive acute lymphoblastic leukaemia

Childhood acute lymphoblastic leukaemia with the classic Philadelphia chromosome translocation is fatal in patients treated with chemotherapy alone. We report probable cures in three adolescents and one child who received extensively reinforced, early chemotherapy followed by rotational treatment with pairs of non-cross-resistant drugs. The median duration of leukaemia-free survival in this subgroup is 6.5 years (range 6-8 years). The two patients with long-term bone marrow surveillance for residual disease showed no evidence of the Philadelphia chromosome at 31 and 53 months post-remission. Such intensive chemotherapy is a reasonable option for patients who are not able to undergo bone marrow transplantation.