Reasons for optimism in the therapy of acute leukemia.

Distinct progress has been made in recent years in the therapy of acute leukemia. For acute myeloid leukemia (AML), this progress has been anchored in the increased understanding of genomic complexity. Multiple targets and the relationships among them pose new challenges along with new possibilities for the development of targeted therapies. A number of new drugs are in early clinical development for AML, one of which centers on the role of isocitrate dehydrogenase (IDH) in malignancy. Epigenetic modulation, intracellular pathways, and the microenvironment are all being explored for possible therapies to treat AML. Dramatic clinical progress has also been made in therapy of acute lymphoblastic leukemia (ALL) with the rapid approval of blinatumomab, a bispecific T-cell engager antibody. Yet caution must also be exercised-not every mutation is an epigenetic target and early publication of clinical data is often misleading. Until the survival outcome for adult patients with acute leukemia improves, further inquiry into the biology of the disease and progress in the development of new therapies are needed.