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Upon completion of the chapter, the reader will be able to:

  1. Describe the pathogenesis of acute leukemia.

  2. Compare the classification systems for acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML).

  3. Identify the risk factors associated with a poor outcome for the acute leukemias.

  4. Explain the importance of minimal residual disease (MRD) and its implication on early bone marrow relapse.

  5. Explain the role of induction, consolidation, and maintenance phases for acute leukemia.

  6. Define the role of CNS preventive therapy for acute leukemia.

  7. Recognize the treatment complications associated with therapy for acute leukemias.

  8. Describe the late effects associated with the treatment of long-term survivors of acute leukemias.




  • Image not available. The acute leukemias are hematologic malignancies of bone marrow precursors characterized by excessive production of immature hematopoietic cells. This proliferation of "blast" cells eventually replaces normal bone marrow and leads to the failure of normal hematopoiesis and the appearance of leukemia cells in peripheral blood as well as infiltration of other organs.

  • Image not available. Acute leukemias are classified according to their cell of origin. Acute lymphocytic leukemia (ALL) arises from the lymphoid precursors. Acute nonlymphocytic leukemia (ANLL) or acute myelogenous leukemia (AML) arises from the myeloid or megakaryocytic precursors.

  • Image not available. The goal is to match treatment to risk and minimize over- or undertreatment. Children and adults with leukemia are sorted into prognostic categories based on clinical and biological features that mirror their risk of relapse. Risk assessment is an important factor in the selection of treatment.

  • Image not available. Minimal residual disease (MRD) is a quantitative assessment of subclinical remnant of leukemic burden remaining at the end of the initial phase of treatment (induction) when a patient may appear to be in a complete morphologic remission. This measure has become one of the strongest predictors of outcome for patients with acute leukemia. The elimination of MRD is a principal objective of postinduction leukemia therapy.

  • Image not available. The initial treatment for acute leukemias is called induction. The purpose of induction is to induce a remission, a state in which there is no identifiable leukemic cells in the bone marrow or peripheral blood with light microscopy.

  • Image not available. The current induction therapy for ALL typically consists of vincristine, l-asparaginase, and a steroid (prednisone or dexamethasone). An anthracycline is added for higher risk patients.

  • Image not available. Leukemic invasion of the CNS is considered to be an almost universal event in patients, even in those whose cerebrospinal fluid (CSF) cytology shows no apparent disease. Thus, all patients with ALL and AML receive intrathecal chemotherapy. Although this is often referred to as "prophylaxis," it more realistically represents treatment.

  • Image not available. Bone marrow relapse is the major form of treatment failure in 15% to 20% of patients with ALL. Most relapses have the same immunophenotype and cytogenetic changes seen in the original disease.

  • Image not available. The current induction therapy for AML usually consists of a combination of cytarabine and an anthracycline daunorubicin or idarubicin, with the frequent addition of a steroid and/or an ...

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