title: Treatment of acute lymphoblastic leukaemia : a new era.
abstract: Acute lymphocytic leukaemia (ALL) is a heterogeneous group of disorders that result from the clonal proliferation and expansion of malignant lymphoid cells in the bone marrow, blood and other organs. Distinct clinicopathological ALL entities have been identified, resulting in the adoption of risk-oriented treatment approaches. Advances in ALL therapy have led to long-term survival rates of >80% in children. However, only approximate, approximately 30-40% of adults achieve long-term disease-free survival. Contemporary ALL treatment programmes include induction, intensified consolidation, maintenance phases and CNS prophylaxis. The optimal treatment of Philadelphia chromosome-positive patients requires the addition of BCR-ABL tyrosine kinase inhibitors, such as imatinib, whereas allogeneic stem-cell transplantation remains the preferred approach for high-risk patients in first remission. Since only approximate, approximately 38% of adult ALL patients are free of disease 5 years after diagnosis and the outcome of salvage chemotherapy is very poor (complete remission rates of 20-30%, median survival of 3-6 months), novel agents are desperately required. Of those currently in clinical studies, the outlook for sphingosomal vincristine, pegylated asparaginase (pegaspargase), liposomal annamycin, ABT-751, pemetrexed, talotrexin, nelarabine and the novel BCR-ABL kinase inhibitors is discussed.
authors.affiliation: Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Effrosyni
authors.initials: E
authors.lastname: Apostolidou
authors.forename: Ronan
authors.initials: R
authors.lastname: Swords
authors.forename: Yesid
authors.initials: Y
authors.lastname: Alvarado
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Giles
mesh_terms: D000208:Acute Disease; D000818:Animals; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002626:Chemistry, Pharmaceutical; D005493:Folic Acid Antagonists / Q000627:therapeutic use; D006801:Humans; D008870:Microtubules / Q000187:drug effects; D009705:Nucleosides / Q000627:therapeutic use; D016374:Oncogene Proteins v-abl / Q000037:antagonists & inhibitors; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D051562:Proto-Oncogene Proteins c-bcr / Q000037:antagonists & inhibitors
chemical_list: D000970:Antineoplastic Agents; D005493:Folic Acid Antagonists; D009705:Nucleosides; D016374:Oncogene Proteins v-abl; D051562:Proto-Oncogene Proteins c-bcr