Childhood acute lymphoblastic leukemia (ALL), one of the first malignant diseases for which large-scale therapeutic trials were conducted, has served as a paradigm for cancer research for over four decades. At present, two thirds or more of children with ALL can be cured with contemporary treatment plans (Table 1).<sup>62 Pui C.-H. Acute leukemia in children Curr Opinion Hematol 1996 ;  3 : 249  [cross-ref]

Cliquez ici pour aller à la section Références</sup> This remarkable success began with the identification of effective antineoplastic drugs in the late 1940s and 1950s, followed by the development of combination chemotherapy and subclinical central nervous system (CNS) leukemia therapy in the 1960s. Refinements in the design and analysis of clinical trials during the 1970s led to the recognition of clinical and laboratory features that connote a poor prognosis, setting the stage for risk-directed therapy. In the 1980s, the following became clear: certain antileukemic agents, as well as cranial irradiation, can produce serious late sequelae; many leukemias arise from nonrandom cytogenetic abnormalities with therapeutic implications; intensive chemotherapy can abolish the prognostic significance of certain adverse features; and some cases of refractory leukemia can be cured with allogeneic hematopoietic stem cell transplantation. Together, these discoveries resulted in greater refinement of risk-oriented therapy that, in time, advanced cure rates to their present high levels. We recently entered the era of molecular medicine, in which genetic probes are being used to recognize new disease categories and improve treatment selection. Ultimately, dissection of ALL at the molecular level should pinpoint sensitive and highly specific targets for therapeutic intervention, leading to treatments that are both safe and uniformly effective. This article emphasizes only recent advances in the management of childhood ALL.