Management of B-Cell Acute Lymphoblastic Leukemia

This chapter addresses the management of adult B-cell acute lymphoblastic leukemia (ALL). The front-line strategy is similar to that in pediatrics: induction chemotherapy, multiple rounds of consolidation, a prolonged maintenance phase, and central nervous system (CNS) prophylaxis. Most therapy protocols take approximately 3 years. Regarding therapies, the roles of anti-CD19, anti-CD20, and anti-CD-22 antibodies are currently being studied. For adult patients who are Philadelphia chromosome positive, allogeneic stem cell transplantation (allo-SCT) is regarded as the only curative intervention, but the addition of tyrosine kinase inhibitors to chemotherapy may produce synergistic effects. The prognosis of adults with relapsed or refractory ALL is generally poor, with median OS ranging between 4 and 7 months. The decision to use a salvage strategy is largely based on the duration of first remission, performance status, and organ function.