Recent advances in the treatment of acute leukemia

This review briefly summarizes literature considered noteworthy in the field of adult acute leukemia published during 1996. Does intensity remains a controversial issue in both acute myelogenous and lymphoblastic leukemia. The most convincing data showing efficacy of high dose fractionated chemotherapy was presented in patients with Burkitt's lymphoma/leukemia; the remainder of clinical studies failed to show a definitive advantage to high-dose therapy. Numerous studies addressed the role of the multidrug resistant phenotype and, at least in adult disease, demonstrated that the presence of this particular phenotype was a poor prognostic indicator. In the pediatric population, the significance of multidrug resistance expression appeared less clear. Discrepancies between protein expression and function were also evaluated in clinical samples and outcomes reported in large clinical series. Among the most interesting scientific investigations were those focused on the molecular mechanisms involved in the specific translocations t(15;17) and t(8;21) in acute myelogenous leukemia and t(12;21) in acute lymphoblastic leukemia. The genes PML and AML1, and ETO were examined in normal hematopoietic progenitors and their fusions proteins, PML/RAR alpha and AML1/ETO, measured in patients in clinical remission, and important data were presented concerning these proteins and measurement of minimal residual disease. Provocative data were also presented suggesting that retinoic acid may induce synthesis of a protein that selectively degrades PML/RAR alpha, and that interferons may regulate PML/RAR alpha expression.