Riskadapted Therapy

The factors described above can be used to provide a general risk assessment for prognosis and treatment planning. As many as 75% of adults with ALL can be considered relatively "high risk," with an expected DFS of 25-35%. Only approximately 25% of patients can be considered "standard risk," with anticipated survival rates of more than 50%. Nevertheless, until recently, most adults with ALL have been treated similarly regardless of patient-specific clinical and biologic risk features. To date, "risk-adapted" therapy in adult ALL has focused primarily on two disease subsets: patients with mature B-cell (Burkitt-type) ALL and those with Philadelphia-chromosome-positive (Ph+) ALL. These two groups are considered separately in the "Treatment" section that follows. The role of dose intensification with SCT in first remission and age-adapted therapeutic strategies will also be reviewed.

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