[Current treatment of acute lymphoblastic leukemia in adults]

Abstract

Acute lymphoblastic leukemia (ALL) is the most frequent malignant disease in childhood. In adults ALL comprises approximately 20 % of all forms of acute leukemia. In recent years substantial progress has been made with respect to the characterization and therapy optimization based on consecutive therapy optimization studies with increasingly more individualized, risk-adapted therapy protocols. Approximately 90 % of adult ALL patients under 55-65 years can now achieve complete remission. The chance of cure for adults could be increased over the last 30 years from less than 10 % to more than 50 %. Fundamental for the improvement of therapy results were an optimization of intensive chemotherapy and supportive treatment, integration of stem cell transplantation into the first-line treatment, inclusion of targeted substances in the therapy concept and improved risk stratification in consideration of the course of the minimal residual disease. Due to individualized therapeutic decisions current therapy protocols are very complex and can only be adequately carried out in specialized centers. Future challenges include further optimization of therapy in older patients and treatment of patients refractory to chemotherapy. In Germany the majority of adult patients are treated according to protocols of the German multicenter study group for adult ALL (GMALL).