Acute lymphoblastic leukemia: Treatment

Over the past thirty years, major progress has been achieved in the treatment of ALL. Many of the concepts, definitions, and principles of chemotherapy have and continue to be derived from studies in ALL. Major and continuing progress is ongoing for the various categories of treatment; that is, remission induction, treatment at sites of high risk for relapse (e. g., pharmacologic sanctuaries), cytoreductive therapy during complete remission, and duration of treatment. Rapid improvement in our understanding of the pathogenesis of ALL and particularly the identification of immunologic and prognostic subcategories of ALL have major therapeutic implications which are in process of being realized. Current research is focused on the development of new chemotherapeutic agents, the more rational basis for the employment of chemotherapeutic agents in combination (cytokinetic, pharmacologic, and related studies), a better definition of the host-tumor relationship particularly with respect to immunologic response and iatrogenic manipulation of such responses, and in the area of supportive care and bone marrow transplantation.