Molecular subsets and prognostic factors in acute lymphoblastic leukemia

Leukemia is a heterogeneous collection of diseases with different molecular origins. The molecular features may provide physicians with markers that can be used to monitor disease. In acute lymphoblastic leukemia (ALL), molecular monitoring methods can be very useful in developing and improving treatment. Some argue that one of the main problems in adult ALL is that it is homogeneous but, in fact, it is a very diverse condition. However, it can't be seen in the surface markers or in the nucleus of these diseases, so there is a need to develop ways to identify these cases. Good and potentially curable subsets of ALL patients are beginning to be identified by combining traditional phenotypic and immunologic markers with molecular and genetic approaches. As treatments improve, definition of therapeutic and prognostic subsets and their significance to clinical outcome is imperative. While progress has been made in the use of molecular techniques to detect residual disease, we must still acquire experience in using these markers to monitor treatment efficacy, with the eventual aim of improving outcome.