[Differences in therapeutic strategies for adult leukemia and lymphoma between Japan and western countries].

The purpose of this paper is to clarify the differences in therapeutic strategies for adult leukemia and lymphoma between Japan and western countries. Since in Japan, high-dose cytarabine for acute leukemia is not covered by health insurance, post-remission therapy might be less intense compared to western countries and it takes a long time to complete the therapy. The results of chemotherapy for adult acute lymphocytic leukemia (ALL) in Japan have been inferior to those in foreign reports. Accordingly, many Japanese hematologists believe that adult ALL has a worse prognosis than acute myeloid leukemia (AML), and almost all young adult patients with ALL should receive allogeneic bone marrow transplantation (BMT) from related or unrelated donors. Japanese hematologists also consider that Interferon as the first-line chemotherapy for chronic myelogenous leukemia (CML), and that BMT from a HLA matched sibling donor should be done as soon as possible. Recently, some foreign reports of BMT from unrelated donors for CML revealed results comparable to BMT from related donors showing that even transplants from unrelated donors should be done as soon as possible. Since chronic lymphocytic leukemia and Hodgkin's disease are so rare in Japan, the available drugs for these diseases are limited. The quality and quantity of Japanese clinical studies in this field are inferior to studies in western countries. This, in fact, is a more serious problem than the differences in therapeutic strategies.