Diagnostic pathways in acute leukemias: a proposal for a multimodal approach

Area of Science:

• Hematology
• Oncology
• Molecular Diagnostics

Background:

• Acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) are complex, heterogeneous disorders.
• Diverse leukemogenesis mechanisms necessitate individualized risk stratification for effective treatment.
• Targeted therapies are available for specific subtypes, like AML M3/M3v and Philadelphia-positive ALL.

Purpose of the Study:

• To emphasize the importance of precise acute leukemia subtype classification at diagnosis.
• To highlight the need for sensitive quantification of minimal residual disease (MRD) during remission.
• To underscore the role of a multimodal diagnostic approach in modern leukemia management.

Main Methods:

• Cytomorphology
• Multiparameter flow cytometry
• Chromosome banding analysis
• Fluorescence in situ hybridization (FISH)
• Molecular analyses

Main Results:

• A multimodal diagnostic strategy is required for accurate acute leukemia classification and MRD quantification.
• The integration of various techniques ensures comprehensive diagnostic evaluation.
• Diagnostic algorithms are essential to guide the process and synthesize results.

Conclusions:

• Exact classification and sensitive MRD monitoring are fundamental for optimal therapeutic strategies in AML and ALL.
• The expanding diagnostic methods demand efficient algorithms for personnel, time, and cost-effectiveness.
• Modern diagnostics rely on a comprehensive, integrated approach for improved patient outcomes.