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Current treatment of adult acute lymphoblastic leukemia.

The survival outcomes for children with acute lymphoblastic leukemia (ALL) have dramatically improved over recent years, and improved outcomes in adolescents and young adults patients have been achieved by applying regimens based on pediatric protocols. The treatment strategies for adult ALL are similar to those for pediatric ALL. T-cell ALL is less common than B-cell ALL. Therefore, there are only few reports of investigations in a large group of adult T-ALL patients. In Japan, nelarabine-combined chemotherapy has been tested in a phase II study in patients with newly diagnosed T-ALL. Patients with Philadelphia chromosome-positive ALL had a poor prognosis. However, the introduction of a tyrosine kinase inhibitor (TKI) has dramatically altered treatment strategies, resulting in complete remission in virtually all patients and an increased proportion of patients who undergo allogeneic stem cell transplantation. The prognosis of adults with relapsed and refractory ALL is extremely poor, and some novel agents are currently under development for relapsed and refractory ALL. This article describes the current treatment strategy and future perspectives for adult ALL.