Acute Lymphocytic Leukemia

ALL is curable in about 80% of children. Large scale clinical trials have been instumental in demonstrating the heterogeneity of ALL and that chemotherapy should be adjusted according to the level of risk present at diagnosis and with an assessment of the early response to Rx. The basic principles are: 1. a stringent risk assessment 2. induce remission with an appropriate combination of drugs 3. to assess early response to therapy 4. to treat drug sanctuaries, mainly in the meninges, testes and ovaries 5. to give maintenance Rx for 2-3 years to eradicate any residual leukemic cells. The results in adult ALL have been less impressive, mainly because of adverse prognostic features at the time of diagnosis, more resistant disease and inability of the elderly to tolerate the chemotherapy. However, results are improving so that up to 40 % of adult patients are potentially curable.

Author(s): Peter R. Galbraith MD, FRCP(C)

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