Acute leukemia in adults: AML and ALL explained
Acute leukemias develop quickly and need treatment quickly. The genetic profile of the leukemia now shapes almost every decision.
Acute leukemia begins in the bone marrow, where immature blood cells — blasts — multiply without maturing and crowd out normal production. The result is what brings most patients to a doctor: tiredness from anemia, infections from a lack of working white cells, and bruising or bleeding from low platelets.
In adults there are two main forms. Acute myeloid leukemia (AML) arises from the myeloid line and is the more common of the two; acute lymphoblastic leukemia (ALL) arises from the lymphoid line and is more frequent in children but also occurs in adults.
How the Diagnosis is Made
A blood count usually raises the suspicion, but the diagnosis is made on the bone marrow. A marrow aspiration and biopsy show the proportion of blasts, flow cytometry identifies their type, and cytogenetic and molecular tests look for the chromosomal and gene changes inside them.
Those genetic results are not a formality. In AML, changes such as FLT3 or NPM1 mutations, and in ALL the Philadelphia chromosome, change both the treatment and the decision about transplantation.
Treatment in Phases
Treatment begins with induction, an intensive course designed to bring the leukemia into remission — the point at which blasts are no longer visible in the marrow. It is followed by consolidation, which aims to remove the leukemia cells that remain below the threshold of a microscope.
Targeted drugs now sit alongside chemotherapy: FLT3 inhibitors in FLT3-mutated AML, tyrosine kinase inhibitors in Philadelphia-positive ALL, and less intensive combinations for older or less fit patients with AML. Measurable residual disease testing tells how deep the remission is.
Where Transplantation Fits
For patients whose leukemia carries a high risk of relapse, an allogeneic transplant in first remission offers the best chance of long-term control. For lower-risk disease, consolidation chemotherapy alone may be enough, and the transplant is kept in reserve.
This is a decision taken early, often while induction is still under way, so that a donor search can begin in time.
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