B-acute lymphoblastic leukemia - The European experience

B-acute lymphoblastic leukemia (ALL) (or L3-ALL), a rare disease, and Burkitt's lymphoma [the majority of B-cell non-Hodgkin's lymphoma (NHL) in children], found more frequently, are different forms of a same disease. Spectacular therapeutic improvements obtained in B-NHL during the past decade benefited B-ALL patients, especially in Europe with the French LMB and German-Austrian BFM protocols. The first studies started in 1981 and, through four consecutive studies, cure rates increased above 70% even when the central nervous system (CNS) was involved. This is due to intensive short-term pulse-combination chemotherapy regimens with 3- to 5-day courses administered with short intervals in between.The three main drugs are: fractionated high-dose (HD) cyclophosphamide (greater than or equal to 1 g/m(2)), HD methotrexate (greater than or equal to 3 g/m(2)) and cytosine arabinoside. Intensive local CNS therapy seems necessary. Treatment should not exceed 8 months; relapses generally occur within the Ist year. Treatment has to be intensive and causes some toxicity-related deaths, rates of which decrease with experience and improvements in supportive care.