Diagnosis and treatment of adult acute leukemia

Abstract

L EUKEMIA has received a great deal of attention since first described in 1845 by Virchow. He described a condition in which the relationship between red and colorless corpuscles was the reverse of normal, coining the term weisses blut or white blood. ~ In 1889, Ebstein introduced leukemia as a distinct clinical entity. Early reports described a rapidly fatal disease and, as late as 1966, the median survival for adults with acute myelogenous leukemia (AML) was only 4 or 5 months. 2 The past 2 decades have shown advances in remission induction rates as well as survival. This progress has occurred as a result of more effective chemotherapeutic agents, improved blood product and antimicrobial support, and specialized nursing care. 3 Although therapeutic questions continue to be central to leukemia research, nontherapeutic studies are rapidly expanding our understanding of the biology of this disease. Epidemiologic, cytogenetic, immunologic, and pharmacologic studies are providing a better appreciation for the great heterogeneity of this disease, as well as a more comprehensive understanding of the biology and clinical behavior of the leukemia subtypes. This report will discuss the epidemiology of acute leukemia, review the diagnostic evaluation, provide a historical background for today's therapeutic treatment strategies, and explore the impact of nontherapeutic studies on treatment and prognosis.