Adult acute lymphoblastic leukaemia: The value of therapy intensification

Results of multiagent chemotherapy protocols as therapy for adult acute lymphoblastic leukaemia in non-randomised multi-institutional studies appear superior to historical controls of less aggressive treatment. However, randomised studies have produced conflicting data and increasing the dosage of chemotherapy in conjunction with bone marrow transplantation has been disappointing. We reviewed retrospectively our experience with 68 adult ALL patients treated over a ten year period. Twenty-six patients received a standard four drug induction regimen without intensification. A second group of thirty-four patients received induction, intensification and re-induction phases of treatment. The results suggest that intensification of therapy does not alter median survival or median duration of remission, although a trend towards more long term disease-free survivors is observed.