Acute leukaemia is as difficult to manage as ever, but over the last 10 years the results of treatment have greatly improved, particularly in children with lymphoblastic disease. Without specific antileukaemic chemotherapy the median survival of both children and adults with any acute leukaemia was less than 3 months from diagnosis. The first big advance occurred in 1948, when dramatic though temporary remissions were induced by aminopterin, a folic acid antagonist.1 Progress continued with the development of other antileukaemic drugs and improved therapeutic programmes in which, as in the treatment of advanced Hodgkin’s disease,2 drugs are used in combination to increase their anti-tumour effect without increasing their toxicity unduly. Combinations of this kind have such advantages that single-agent therapy in acute leukaemia is now obsolete.3 4
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