Acute lymphoblastic leukemia (ALL) is the most frequent neoplastic disease in
children, being a rare disease in adults. Many of the advances in pediatric ALL
have been through modifications in the doses and schedules of available agents
as opposed to the introduction of new compounds. In recent years some
improvements in the outcome of ALL in adults have occurred. Application of
pediatric regimens to young and middle-aged adults shows promise to improve
outcome. Advances in the supportive care of patients undergoing allogeneic stem
cell transplantation (SCT), the use of alternative sources of hematopoietic stem
cells and the use of reduced-intensity conditioning regimens will expand the
number of patients who can benefit from this therapeutic modality. The
evaluation of minimal residual disease will further stratify risk classification
and redefine the role of therapeutic modalities such as SCT or biologic agents.
New drugs such as thyrosin kinase inhibitors or monoclonal antibodies have led
to incremental improvements in outcome. Advances in the genetic and epigenetic
mechanisms of the disease provide hope that targeted therapies can more
effectively treat the disease with less toxicity