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Acute lymphoblastic leukemia (ALL) comprises a group of lymphoid neoplasms that are morphologically and immunophenotypically similar to B and T lineage progenitors. The pathogenesis of ALL involves the abnormal proliferation and differentiation of clonal populations of lymphoid cells. Studies in pediatric populations have identified genetic syndromes that predispose to a small number of ALL cases, including Down\\\'s syndrome, Fanconi\\\'s anemia, Bloom\\\'s syndrome, ataxia-telangiectasia, and Nijmegen\\\'s breakdown syndrome. Acute lymphoblastic leukemia has been hailed as a major success story in pediatric oncology with the advent of dose-escalating chemotherapy and allogeneic SCT. However, the high risk of this disease and the significant toxicities associated with chemotherapy in adults make the results less promising. Because some studies have shown benefits of pediatric-inspired therapies, much uncertainty remains about how adults with ALL can best be managed.