Paediatric Acute Leukaemia: State-of-the-art Management in the Era of Precision Medicine and Immunotherapy
Minakshi Bansal, Amita MahajanBackground:
Acute leukaemia is the most common childhood malignancy, comprising predominantly acute lymphoblastic leukaemia (ALL) and, less frequently, acute myeloid leukaemia (AML). Over the past several decades, advances in disease biology, molecular diagnostics, risk-adapted therapy and supportive care have substantially improved survival outcomes in children with acute leukaemia.
Methods:
A narrative review of the contemporary literature was undertaken to summarise recent developments in the epidemiology, molecular characterisation, risk stratification and management of paediatric acute leukaemia, with particular emphasis on measurable residual disease (MRD)-guided therapy, targeted therapeutics and immunotherapeutic approaches.
Results:
Genomic profiling and MRD assessment have transformed risk stratification and treatment individualisation in both ALL and AML. In ALL, incorporation of immunotherapeutic agents has significantly improved outcomes in relapsed and refractory disease. In AML, advances in molecular diagnostics have enabled the development of targeted therapies, thus impacting overall outcomes. Contemporary treatment protocols have resulted in survival rates exceeding 90% for ALL and approaching 70%–80% for AML in specialised centres.
Conclusion:
The integration of molecular diagnostics, MRD-guided treatment strategies, targeted therapies and immunotherapeutic approaches is redefining the management of paediatric acute leukaemia. Continued efforts to improve access to these advances and strengthen supportive care infrastructure are essential to further improve survival and reduce global disparities in outcomes.