Feature Article

Adult leukaemias: prognostic classification and treatment

Feature Article

Adult leukaemias: prognostic classification and treatment

Ken Bradstock

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Abstract

Improved understanding of the molecular basis of leukaemias in adults has led to major changes in the diagnosis, classification and treatment of these diseases.

Key Points

  • Leukaemia in adults is not a single disease but a number of biologically and clinically distinct syndromes.
  • Advances in the understanding of the molecular basis of leukaemia has improved prognostic classification (most notably in acute myeloid leukaemia) and radically changed therapy (especially in chronic myeloid leukaemia and acute promyelocytic leukaemia).
  • Accurate diagnosis is critical and hinges on expert haematopathological examination of blood and marrow samples, aided by specialised cytogenetic, flow cytometry and molecular biology studies.
  • Potentially curative therapy can be offered to younger patients (under 60 years of age) with acute myeloid leukaemia and chronic myeloid leukaemia.
  • The management of chronic lymphocytic leukaemia depends on whether initial therapy is necessary or not, a decision based on individual clinical factors as well as the biological characteristics of the disease.
  • General practitioners are well placed for the follow up of chronic lymphocytic leukaemia patients with nonprogressive disease.