Treatment of childhood and adult acute lymphoblastic leukaemia

In the last 30 years the treatment of acute lymphoblastic leukaemia has radically changed and intensified and has resulted in improvements in the chances of cure in children to up to 70% but in adults only 30% will achieve long-term disease-free survival. Data from large therapeutic trials have determined good and poor prognostic risk factors which have been of use in planning risk-directed treatment protocols and can influence the chance of cure. However intensification of treatment has also been associated with increased toxicity and significant late effects, particularly in children. In the future it will be necessary for more international collaboration and a more uniform approach to treatment in order to achieve continued improvements in the survival from this disease. In children it will be necessary to focus efforts on improving treatment of relapsed patients: chemotherapy protocols in those with a first remission of > 36 months, or for the high-risk patients with a shorter first remission, new transplantation approaches directed towards enhancing the graft-versus-leukaemia effect are going to be of increasing importance. In adults, continued efforts will be directed towards improving first remission rates with the use of increasingly intensive chemotherapeutic protocols and growth factors. The use of unrelated donor transplantation is also likely to increase, particularly in patients with 'poor-risk' disease.