Much new information about ALL in adults has recently been learned from major clinical and laboratory studies. However, much of the recently reported improved management of this leukemia pertains only to younger patients. Elderly patients do not fair very well with modern therapy, including intensified treatment approaches. The question arises whether current treatment may be unnecessarily intensive, not only for elderly patients but for most patients. There are no prospective, randomized studies that clearly demonstrate that anthracyclines, cyclophosphamide or cytarabine are required for optimal results in this leukemia. Eliminating drugs of marginal value but with the potential for considerable toxicity may allow us to intensify treatment with drugs that are most effective at a cost of even less toxicity than usually expected.
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