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The biology and therapy of adult acute lymphoblastic leukemia
Version of Record online: 25 AUG 2003
Copyright © 2003 American Cancer Society
Volume 98, Issue 7, pages 1337–1354, 1 October 2003
How to Cite
Faderl, S., Jeha, S. and Kantarjian, H. M. (2003), The biology and therapy of adult acute lymphoblastic leukemia. Cancer, 98: 1337–1354. doi: 10.1002/cncr.11664
- Issue online: 18 SEP 2003
- Version of Record online: 25 AUG 2003
- Manuscript Accepted: 30 JUN 2003
- Manuscript Revised: 11 JUN 2003
- Manuscript Received: 3 APR 2003
- acute lymphoblastic leukemia;
- adult acute leukemias;
- Philadelphia chromosome;
- risk-adapted therapies
Much progress has been made in understanding the biology of acute lymphoblastic leukemia (ALL). This has translated into the recognition of several subgroups of ALL and the institution of risk-adapted therapies. New therapies are emerging based on the definition of specific cytogenetic-molecular abnormalities.
A review from the English literature, including original articles and related reviews from Medline (Pubmed) and abstracts based on publication of meeting material, was performed.
Changes in the pathologic classification of ALL have led to therapeutic consequences. Adaptation of successful treatment strategies in children with ALL has resulted in similar complete response rates in adults. Prognosis has especially improved in mature–B-cell and T-lineage ALL. The role of tyrosine kinase inhibitors in Philadelphia chromosome–positive ALL was evaluated in the current study. However, regardless of the ALL subgroup, long-term survival of adults is still inferior to that in children.
Intense clinical and laboratory research is attempting to close the gap in outcome between children and adults with ALL. Investigations are focusing on 1) refinement of the basic treatment stratagem of induction, consolidation, and maintenance; 2) expansion of risk-based, subgroup-oriented therapies; 3) assessment of minimal residual disease, its impact on disease recurrence, and its practical implications in clinical practice; 4) salvage strategies; 5) the role of stem cell transplantation in ALL; and 6) the development of new drugs based on a better understanding of disease biology. Cancer 2003;98:1337–54. © 2003 American Cancer Society.