Maintenance chemotherapy and cure of childhood acute lymphoblastic leukaemia

Lancet. 1991 Nov 23;338(8778):1315-8. doi: 10.1016/0140-6736(91)92604-z.


Maintenance chemotherapy with 6-mercaptopurine and methotrexate, widely believed an essential contribution to the high cure rates achieved in children with acute lymphoblastic leukaemia (ALL), is thought to work by killing the leukaemia cells that remain after intensive chemotherapy. We suggest instead that ALL commonly arises in precursor B cells normally programmed to die, and that maintenance chemotherapy does not kill these cells but controls growth of the leukaemia clone so that programmed death can occur. A similar approach may apply to other cancers in which programmed death is intrinsic to the normal counterparts of the neoplastic cells.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • B-Lymphocytes / drug effects
  • B-Lymphocytes / physiology
  • Bone Marrow / pathology
  • Child
  • Humans
  • Long-Term Care / methods
  • Mercaptopurine / administration & dosage
  • Methotrexate / administration & dosage
  • Neoplasm Recurrence, Local / prevention & control
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / mortality
  • Survival Analysis


  • Mercaptopurine
  • Methotrexate