John Libbey Eurotext



Acute leukemia in adults Volume 17, issue 3, Mai-Juin 2011


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Service d’hématologie, Hôpital Purpan, CHU de Toulouse, 1 place du Dr Baylac, 31059 Toulouse Cedex 9, Service d’hématologie, Hôpital Purpan, CHU de Toulouse, 1 place du Dr Baylac, 31059 Toulouse Cedex 9 ; Centre de recherche en cancérologie de Toulouse, UMR 1037 Inserm - Université Toulouse 3 - ERL5294 CNRS, CHU Purpan, BP 3028, 31024 Toulouse Cedex 3

Acute leukemias in adults represent a group of malignancies derived from the oncogenic transformation of hematopoietic progenitors. Although their mode of revelation is relatively stereotyped, most often by symptoms of bone marrow failure rarely by a tumor syndrome, it is a very heterogeneous set of entities. The diagnosis requires a sophisticated work-up combining cytogenetic, immunophenotypic and molecular analysis currently used for the new WHO classification. Cytogenetics and molecular typing is of major importance for the prognosis of both acute myeloid and lymphoid leukemia and also to stratify consolidation treatments, including indications for hematopoietic stem cell transplantation. The level of response to chemotherapy is also better appreciated by molecular biology to detect one residual leukemic cell up from 10,000 to 100,000 normal cells. Treatment strategies, tailored to the risk of relapse, are based on intensive chemotherapy and hematopoietic stem cell transplantation. In older patients, the prognosis remains very poor mainly because of resistance to chemotherapy otherwise poorly tolerated. Scores of geriatric comorbidities may help the therapeutic decision. Finally, deciphering genetics and epigenetics of acute leukemia cells revealed recurrent oncogenic abnormalities accessible to targeted therapies suggesting that significant therapeutic advances may be achieved in the near future. This article will help students, general practitioners or hematologists to get an overview of the subject and enable them to acquire the basis for diagnosis, specific care and for a better information to patients and their relatives.