[Treatment of acute lymphoid leukemia in adults]

Treatment of adult acute lymphoblastic leukemia (ALL) consists of two parts: induction of complete remission (CR) using a triple chemotherapy with prednisone, vincristine and one anthracycline associated in the majority of protocols with either asparaginase or cyclophosphamide or cytosine arabinoside. A CR rate of 75% can be obtained. The second part is the treatment during remission with 3 phases: early intensification or consolidation by chemotherapy, prevention of leukemia in the central nervous system and maintenance. Alternative strategies are allogeneic or autologous transplantation after myeloablative therapy. Overall long term survival is between 25 and 40%, for less than in children. Future direction of treatment are: better definition of heterogeneous forms of the disease with standard or high risk of relapse allowing adjustment of the treatment. Karyotype analysis, and molecular biology are mandatory to define high risk ALL such as Ph1 + ALL and also to know the level of residual disease during remission. For treatment strategy efficacy of transplantation must be improved (less toxicity for allogeneic BMT, less relapse for autologous BMT and more efficient chemotherapy regimen).