Acute Lymphocytic Leukemia

By Alvin M. Mauer I T IS TRULY gratifying to review the progress that has been made in the therapy of the acute leukemias since the introduction of aminopterin by Farber and coworkers’ in the late I 940s. This progress can be measured by the increasing proportion of patients who have achieved complete remission, the increasing duration of their survival, and the increasing evidence that for some portion of patients with acute leukemia cure is a realistic goal. As these improvements in patient care have accrued, there has been an equally important improvement in our knowledge about the acute leukemias and the application of that knowledge to treatment strategies. Clinical therapeutic research in the treatment of acute leukemia has provided an important experience in the design and conduct of clinical trials in which therapeutic regimens were tested and compared. Knowledge acquired about the treatment of acute leukemia has had an important bearing on the treatment ofother forms ofdisseminated cancer. The study of therapy for the acute leukemias, therefore, has general interest for the physician treating patients with cancer. It has also been evident that the question being asked in clinical studies and the answers being obtained have undergone a continuing evolution. Initially, the important question was simply the method by which a complete remission could be most frequently and quickly obtained. As effective combination chemotherapy regimens for remission induction were designed, the emphasis shifted to a consideration of the problems involved in maintaining that remission. New solutions brought new problems and it is the purpose of this review to outline the current status for therapy of the acute leukemias and, in particular, what current questions are in need of answers.