Personalized medicine in acute leukemia

Personalized medicine in acute leukemia has become a reality. The diagnostic procedures, including immunophenotyping, cytogenetics,molecular genetics, and new genomics, have allowed the definition of new ALLand AML sub-entities which, in some cases, has translated into specific therapies. A great achievement is the possibility of evaluating minimal residual disease (MRD) of ALL patients. MRD is the most important prognostic factor and thus a major component of a personalized treatment algorithm. Progress has also come from targeted therapies,extending the existing backbones of chemotherapy and stem cell transplantation .Targeted therapy in philadelphia chromosome-positive ALL with tyrosine kinase inhibitors and immunotherapy with monoclonal antibodies targeting surface antigens expressed on leukemic blast cells have extended .A new promising approach is the activation of patients’ Tcells directed against their own leukemic blast cells either through a bi specific antibody, or chimeric antigen receptor modified T cells.In Acute myeloid leukemia for decades, pretreatment karyotype evaluation has served to identify subgroups for risk-adapted post remission therapy, but the initial treatment approach has been largely unchanged. Nowadays AML is categorized into biologically defined groups .Identifying the genetic abnormalities and biological drivers prior to AML treatment will be important as we work to individualize therapy and improve outcomes