High-Dose Cytosine Arabinoside in the Treatment of Acute Lymphoblastic Leukaemia

“High-dose” cytosine arabinoside (HD-ara-C) was introduced into the management of acute lymphoblastic leukaemia (ALL) in adults at St. Bartholomew’s Hospital (SBH), London, Ospedali Riuniti, Bergamo and Ospedale San Bortolo, Vicenza in 1981. Prior to this time, a strategy of remission induction and consolidation with adriamycin, vincristine prednisolone and L-asparaginase (OPAL) [1,2], with subsequent dose escalation and addition of cyclophosphamide (HEAV’D) [2,3], followed by cranial irradiation and maintenance chemotherapy, left much room for improvement. Analysis of the prognostic significance of pretreatment variables made it possible to assign patients to either “low-risk” (cALLa positive, blast count < 10 × 109/I) or “high-risk” (the rest) categories [2].