Acute lymphoblastic leukemia (ALL) is an uncommon disease in adults. It is initially very responsive to chemotherapy and the vast majority enters remission. However, relapse is common and the ultimate long-term survival rate hovers at approximately 20-30%. Poor prognostic factors include very young or old age, high WBC count at diagnosis, the presence of the Philadelphia chromosome (Ph+), and slow initial response to therapy (Table 35.4).40

The chance for long-term RFS after relapse without transplant is very limited. It seems paramount to adequately achieve initial leukemic control due to low response rate to salvage and lack of durability of subsequent remissions, regardless of consolidation strategy.

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