In the past 20 years major advances in terms of biological characterisation and outcome of adult acute lymphoblastic leukemia (ALL) have been achieved. More recently there was no further improvement of overall results in larger prospective trials but significant advances for distinct biological subgroups of ALL such as mature B-ALL and T-ALL. The paper will give a brief review on the results of chemotherapy, indications and results of bone marrow transplantation and CNS prophylaxis in adult ALL. Furthermore it will characterise immunological subgroups of ALL and give an overview on well known prognostic factors and new parameters such as minimal residual disease (MRD). These risk factors are included in a suggested new risk model for adult ALL. Subtype adjusted therapy, rational treatment decisions based on MRD and new, 'causative' treatment approaches are highlighted as the most promising perspectives for future improvement of treatment results in adult ALL.