Acute leukaemia

• Autores: Anne Mwirigi, Richard J. Dillon, Kavita Rai
• Localización: Medicine, ISSN-e 1357-3039, Vol. 45, Nº. 5, 2017, págs. 280-286
• Idioma: inglés
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• Resumen

  • The acute leukaemias consist of acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). ALL occurs predominantly in children whereas AML occurs mainly in elderly individuals. They can present as medical emergencies such as neutropenic sepsis, hyperleucocytosis and coagulopathy. Whereas 80% of children with ALL are cured, the outcomes for most AML patients remain poor, and treatment strategies to improve this are needed. In both ALL and AML, recurrent cytogenetic abnormalities have prognostic significance. A normal karyotype confers intermediate risk in AML and ALL but comprises a heterogeneous group with varied outcomes. Whole-exome sequencing of patients with normal-karyotype AML reveals recurrent molecular mutations in FLT3, NPM1, CEBPA, IDH1, IDH 2 and DNMT3A that are of additional prognostic and possible therapeutic value. Although the mainstay of treating acute leukaemia remains chemotherapy with additional allogeneic stem cell transplantation as consolidation in high-risk disease, the discovery of novel molecular mutations may result in personalized therapy with drugs that target the abnormal pathways and also offer a marker that can be used to monitor minimal residual disease. The ability to detect minimal residual disease enables the possibility of early intervention to prevent relapse. Cumulatively, these approaches may improve the outcomes in acute leukaemia.