Acute lymphoblastic leukemia and lymphoma in adults

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. Therefore, proper diagnostic workup with leukemic-cell phenotyping, cytogenetics, and molecular diagnosis, including identification of the BCR-ABL fusion gene, is critical for prognostication and for guiding appropriate therapeutic choice. Progress has been made in moving toward tailored treatment that is more age specific and biologically relevant. Recent results suggest that applying age- and risk-adopted therapeutic strategies using several components of complex pediatric protocols may lead to improved outcome in adult patients with ALL. Participation in well-designed clinical trials is critical for future progress in the management of adult patients with ALL.