Acute lymphoblastic leukemia (ALL) in adults is an uncommon but devastating malignant proliferation of lymphoid precursors. Treatment programs for adult patients are largely based on pediatric regimens. However, cure rates in adults have been limited to 30-40% for the past several decades as opposed to the 80% cure rate in children. Treatment of adolescents and young adults is evolving with the adoption of more aggressive "pediatric-inspired" treatment programs. The role of allogeneic stem cell transplant is first remission remains controversial in spite of recent data suggesting improved outcomes in patients younger than 35. Kinase inhibitors in combination with standard chemotherapy have significantly improved outcomes in ALL associated with the Philadelphia chromosome. The treatment of ALL in the elderly remains challenging. Promising new agents such as nelarabine and clofarabine may improve the outlook. This article reviews the current state of the art for the treatment of ALL in adults.
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