Since 1987 Acute Leukemias (AL) has regularly reported on the state of the art in the rapidly growing, successful and exciting field of biology and management of these diseases. In this volume large multicenter clinical trials again form the solid basis for the investigation of leukemic cell biology, the detection of biologic subgroups, their differential response to alternative treatment strategies and the further development of therapy. In particular, this volume addresses mechanisms of chromosomal translocations and transcription factors, risk-adapted treatment strategies, differentiation therapy, secondary AL, special aspects in older patients, and adoptive immunotherapy. Besides the antileukemic approaches, supportive treatment with new antimicrobial substances and growth factors is updated. As a forum of worldwide activities in the field of AL this volume contains both exhaustive overviews on major clinical issues and preliminary data and hypotheses not previously published.

Following the major breakthroughs in the and frequent and thorough exchange of treatment of acute leukemias in the seven- information. Hence, it was felt that a spe- ties by the introduction of intensive combi- cial series of symposia should be devoted to nation regimens, therapeutic progress has "Pharmacokinetics and Management of slowed down and the impression of stagna- Relapsed and Refractory Disease" comple- menting the established meetings on "Prog- tion may even have occured. In contrast, the knowledge about the biology of leu- nostic Factors and Treatment Strategies" kemias is rapidly expanding and allows new which will proceed in parallel. It was the insights into the pathophysiology of the aim of the international symposium disease. Further improvements also come "ACUTE LEUKEMIAS - Pharmacokine- from a better understanding of the pharma- tics and Management of Relapsed and cokinetics and pharmacodynamics of cyto- Refractory Disease" to provide an update static drugs and their mechanisms of action. of the present knowledge in this area and to Hence, novel treatment modalities can be stimulate further developments. As a sign developed on a more solid basis and ration- for the closing distance between countries al. These achievements need to be comple- and the development of effective world- mented by effective eradiation wide cooperation this symposium emerged of residual disease or its permanent control and new from the joint efforts of the German AML approaches have been derived from recent Cooperative Group and the M. D.

The rates of acute leukemia cure have gradually improved over the last decade. Clinical study results reflect the impact of chemotherapy intensity and duration, the role of prolonged maintenance, intensified consolidation or very early intensification. Further progress has also been achieved in bone marrow trans plantation, and recent prospective studies and meta-analyses have contributed comparisons of the high antileukemic efficacy of bone marrow transplantation to that of improved chemotherapy. This allows a more successful combining of the two forms of treatment. New prognostic factors have emerged from both cytogenetic and molecular genetic research. Thus, the Philadelphia chromosome translocation and the bcr/abl gene rearrangement have proven to be the dominating risk factor in acute lymphoblastic leukemia. Since the frequency increases with age, differences in prognosis between children and adults can be explained. Evaluation of molecular and immunologic leukemia cell markers has provided a better understanding of residual leukemia in clinical remission, as a prognostic factor and in monitoring the effectiveness of the antileukemic strategy. Recent work on leukemic cell biology has resulted in novel therapeutic approaches such as terminal differentiation by all-trans-retinoic acid, modulation of chemotherapy by hematopoietic growth factors such as GM-CSF and enhancement of immunologic control by cytokines such as interleukin 2. New antimicrobial drugs and the application of mostly empiric anti-infectious strategies have helped reducing the therapeutic risk. Thus, a number of recent achievements have provided us with new options in the management of patients with acute leukemias."