Acute leukemia in adults

Several trends are emerging in the treatment and investigation of acute leukemia in adults; in this review both of these aspects are addressed. Chemotherapy forms the mainstay of treatment for acute myeloblastic leukemia. In the past year, groups reported on the value of dose intensification in patients with acute myeloblastic leukemia under the age of 60 years and on the role of intensive chemotherapy combined with growth factors in the treatment of elderly patients. Similarly, the role of autologous bone marrow transplantation for older patients has been studied. Improvements in the treatment of patients with acute leukemia are likely to come from a recognition and understanding of the biologic attributes of the leukemic cell. Failure to cure leukemia is likely due to failure to eradicate the leukemic clone. Mechanisms of drug resistance acting before the drug reaches its target (proximal resistance) and after the drug interacts with its target (distal resistance) are gaining greater importance in understanding treatment failures. Advances have been made in identifying new mechanisms that are involved in proximal as well as distal drug resistance. Genetic changes both at the cytogenetic and the molecular level identify different FAB subgroups and groups of patients with good and bad prognostic features. Finally, reports are reviewed of two new factors that stimulate the growth of acute myeloblastic leukemia cells (thrombopoietin and Flt3 ligand) and a factor that inhibits the autocrine growth characteristics of acute myeloblastic leukemia cells (interleukin-10). The results of these interface and basic studies offer the hope of identifying groups of patients with different therapeutic needs and suggest ways to develop therapies aimed at the biology of the leukemic cell.