19. Acute Leukemia

  1. Alvin H. Schmaier MD and
  2. Hillard M. Lazarus MD, FACP
  1. Tsila Zuckerman MD and
  2. Jacob M. Rowe MD

Published Online: 22 SEP 2011

DOI: 10.1002/9781444345254.ch19

Concise Guide to Hematology

Concise Guide to Hematology

How to Cite

Zuckerman, T. and Rowe, J. M. (2011) Acute Leukemia, in Concise Guide to Hematology (eds A. H. Schmaier and H. M. Lazarus), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444345254.ch19

Editor Information

  1. Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH, USA

Author Information

  1. Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

Publication History

  1. Published Online: 22 SEP 2011
  2. Published Print: 4 NOV 2011

ISBN Information

Print ISBN: 9781405196666

Online ISBN: 9781444345254

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Keywords:

  • acute myelogenous leukemia (AML);
  • acute lymphocytic leukemia (ALL);
  • prognostic factors;
  • induction;
  • consolidation;
  • maintenance;
  • autologous HCT;
  • allogeneic HCT

Summary

Acute leukemias, either of the myeloid or of the lymphoid precursors, are heterogeneous diseases evolving from cooperating gene mutations, involving critical pathways in both differentiation and proliferation of the hematopoietic precursors. Recent advances in understanding these biological entities have enabled prediction of prognosis and hence serve as a first step in adopting patients' specific therapy and developing targeted therapy. There have been major advances in the diagnosis of leukemia with the use of flow cytometry, FISH (fluorescence in situ hybridization), cytogenetics, molecular markers, gene expression profile and other sophisticated laboratory methods. In addition, improved supportive care with the use of novel anti-bacterial and anti-fungal antibiotics, administration of better processed blood products, hematopoietic growth factors, new anti-leukemic agents and advanced hematopoietic cell transplantation (HCT) techniques all have contributed to increased survival rate in leukemia patients. The anticipated overall outcome for adults up to age 55 or 60 years has improved from 11% in the 1970s to 40% in the current era, although the cure rate for older patients with AML is low. In pediatric patients the ALL cure rate is between 80–90%; although adults have a 90% chance for entering complete remission (CR), relapse after remission continues to plague this group and the long-term disease-free survival is only ∼30–40%. Allogeneic HCT increases the long-term overall survival to about 60% in standard-risk patients.