Acute leukaemia

Abstract

The acute leukaemias consist of acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL), which typically present in older adults and childhood, respectively. Uncontrolled proliferation of abnormal, immature blasts leads to bone marrow failure and cytopenias, which may present as medical emergencies (e.g. leukostasis, catastrophic coagulopathy). Approximately 90% of children with ALL are cured. The outcomes of AML patients are more heterogenous but have improved significantly in recent years through optimization of supportive care and incorporation of targeted therapies. Lineage distinction (AML vs ALL) is attained first through morphology and flow cytometry. Exclusion of acute promyelocytic leukaemia, an AML subtype with a very high early death rate without appropriate treatment, must occur within hours of presentation of a patient with suspected acute leukaemia. Cytogenetics and comprehensive molecular testing further delineate specific subtypes, prognosis and therapeutic targeting. Treatment of acute leukaemias is centred around three aims: (1) attainment of complete remission (CR) via induction; (2) maintenance of CR via consolidation and/or maintenance therapy, including consideration of allogeneic stem cell transplant for high-risk patients; and (3) early detection of impending relapse through measurable residual disease monitoring, affording early pre-emptive therapy. Cumulatively, these approaches have improved the outlook of patients with acute leukaemias.