Modern treatment programs for adults with acute lymphoblastic leukemia.

The current treatment programs for adult patients with acute lymphoblastic leukemia are modeled on pediatric regimens. The result has been complete remission rates comparable to those seen in children, but a significant proportion of adult patients relapse. Salvage therapy for patients with acute lymphoblastic leukemia continues to have limited success. Advances in molecular biology have discovered new targets for therapeutic intervention, and the introduction of some targeted agents, such as the new tyrosine kinase inhibitors and monoclonal antibodies, has led to improvements in response and survival in some subsets. The development of techniques for identification and monitoring of minimal residual leukemia has provided possible ways to predict relapse and consider early intervention. It is likely that we will further refine therapeutic approaches and improve patient outcome through the translation of biologic and molecular discoveries into effective and risk-adapted strategies.