ABSTRACT
Epidemiology 1092 Etiology 1093 Genetic predisposition 1093 Environmental factors 1093 Approach to diagnosis 1093 Immunologic classification of acute 1093
lymphoblastic leukemia Cytogenetic and molecular genetics of acute 1094
lymphoblastic leukemia Clinical manifestations 1097 Laboratory evaluation 1099 Differential diagnosis 1099 Therapy 1099 Supportive therapy 1099 Infection management 1100
Chemotherapy 1100 Transplantation 1108 Treatment algorithm 1110 Therapy for recurrent and resistant acute 1110
lymphoblastic leukemia Novel agents for adult acute lymphoblastic leukemia: 1110
a prospective look Purine nucleoside analogues 1110 Signal transduction inhibitors 1111 Src inhibitors 1111 Antiangiogenesis agents 1112 Epigenetic therapy 1112 Summary and future directions 1113 Key points 1113 References 1114
Almost 5500 cases of acute lymphoblastic leukemia (ALL) were predicted to be diagnosed in 2008 in the United States,1 approximately one-third of which would be in adults. Acute lymphoblastic leukemia is a heterogeneous group of potentially curable lymphoid disorders that results from monoclonal proliferation and accumulation of lymphoblasts in the bone marrow, peripheral blood, and other organs. Acute lymphoblastic leukemia is a sharply contrasting disease in pediatric and adult populations. Excellent medical progress in the therapy of childhood ALL has been made, with steady improvement over the past five decades; combination chemotherapy and central nervous system (CNS) prophylaxis have improved the cure rate of ALL in children from 5 percent in 1950 to 85 percent in 2000.2
Following the lead from the pediatric experience, doseintense multiagent regimens administered to adult patients with ALL now achieve remission rates exceeding 80 percent but with 5-year survival of only around 40 percent.3 Current therapy for adults with ALL has become increasingly dependent on patient-and disease-specific characteristics.
