Acute lymphoblastic leukemia

Advances in the understanding of childhood acute lymphoblastic leukemia (ALL) have transformed the disease from a rapidly progressive and usually lethal disorder to a disease with an 80% cure rate. These improved outcomes are owing to the development of multiagent, dose-intensive chemotherapy regimens, central nervous system prophylaxis, and improved supportive care. In parallel to the improved understanding of therapeutic approaches to ALL, knowledge of the pathogenesis of ALL has increased dramatically. But uncovering the molecular mechanisms behind this disease has not yet produced targeted therapies that specifically act on these elements, as has been the case, for example, with tyrosine kinase inhibition for chronic myelogenous leukemia. Such novel treatment approaches are needed in particular in adult ALL, which although morphologically indistinguishable from pediatric disease, has a considerably poorer response to chemotherapy and remains incurable in>50% of the cases. These differences are in part resulting from differing molecular pathogenesis, which results in a higher proportion of tumors with de novo pan-drug resistance