The treatment of adults with acute lymphoblastic leukemia (ALL) has been modeled on therapy developed for childhood ALL. The similarity between childhood and adult forms of this disease allows for inferences to be drawn from experience in the pediatric population. However, adults with ALL have far poorer outcome when compared to children. Some of this difference can be attributed in ability to tolerate intensive therapy coupled with an increased incidence of unfavorable cytogenetic subgroups and a decreased incidence of favorable cytogenetic subgroups. Treatment of adult ALL is typically divided into four broad categories: induction, consolidation, maintenance, and central nervous system prophylaxis. Despite three decades of clinical investigation for devising improved treatment programs for adults with ALL, no single program has emerged as the standard. Here we review classification, prognostic features, current treatment programs, and new advances as applied to adult patients with newly diagnosed ALL.