All clinicians should know the basic nature of acute leukemia, how to make the diagnosis, and be able to discuss the principles of treatment and the prognosis with their patients. While treatment is still mainly based on non-specific cytotoxic chemotherapy, progress in research is leading to the identification of an increasing number of molecular genetic abnormalities to which new drugs can be specifically targeted. At the molecular level A leukemogenic event causes a genetic mutation in a single stem cell. This initiates the process by blocking maturation of that cell. This "immortalized" cell is essentially harmless until a second activating mutation comes along to provide the proliferation signal needed for it to grow fast enough to expand and dominate the hempoietic system. At the clinical level The leukemic clone causes: - bone marrow failure (pancytopenia) - a raised WBC count - organ/ tissue infiltration Leukostasis - where with a very high blast cell count, causes blasts to clump and plug the microcirculation: - the blasts release cytokines which interact with vascular endothelium. This is rapidly fatal unless treated promptly. The clinical features depend on which organs are infiltrated in a given patient.
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