Treatment of adult acute leukemia.

The epidemiology, etiology, pathophysiology, classification, and clinical appearance of adult acute leukemia are reviewed, and treatment strategies are discussed. Some 18,000 Americans die of leukemia each year, with acute leukemia account for half of these deaths. The etiology of acute leukemia is unknown, but current theories propose that the disease is caused by environmental factors acting on a genetically susceptible host. Acute leukemia occurs when a single hematopoietic precursor cell undergoes neoplastic transformation; autonomous proliferation of the leukemia clone continues until the patient dies of infection or bleeding. Acute leukemias are broadly classified as myelogenous and lymphocytic on the basis of cell lineage. Signs and symptoms are related to infiltration of the bone marrow by leukemic cells and the resultant failure of normal hematopoiesis. Therapy for acute myelogenous leukemia includes remission induction and consolidation with an array of antineoplastic agents. Allogeneic or autologous bone marrow transplantation is the therapy of choice for eligible patients in the first complete remission. Neither low-dose maintenance therapy nor prophylaxis for CNS involvement is indicated. Therapy for acute lymphocytic leukemia includes induction, consolidation, maintenance, and CNS prophylaxis. Allogeneic bone marrow transplantation should be reserved for standard-risk patients in second or subsequent complete remission and for high-risk patients in first remission. Intensive combination chemotherapy and bone marrow transplantation have improved the outlook for many adult patients with acute leukemia.