Risk-adapted treatment of adult acute lymphoblastic leukemia (ALL).

Modern intensive chemotherapy programs have identified several important prognostic factors for treatment outcomes in adult acute lymphoblastic leukemia. This has allowed clinicians to tailor treatment regimens designed specifically for the various patient subgroups. Of adult ALL patients, 75% have B-lineage disease, and certain biologic characteristics in these patients, including older age and the incidence of mediastinal and CNS disease, differentiate them from T-cell patients. Most of the high-risk cytogenetics are found in the B-lineage group, making cytogenetics the single most powerful prognostic factor in ALL after failure to respond to initial treatment. Currently, there is no subgroup of ALL patients in which standard chemotherapy can be described as adequate, and improved treatment is needed for all groups of patients. These improvements will come from prospective randomized trials. At this time, allogeneic transplant remains the treatment of choice for high-risk ALL.