Why Everybody with Acute Leukaemia is not treated with a Curative Intent

Since acute leukaemia is a rapidly developing disease, it is fatal unless treated as soon as possible. Untreated patient can die within month. Therefore, quick treatment is mandatory. It is very hard to predict the response to the treatment because different people respond differently. Some may get cured, and some may have recurrences. Some of they may even not respond at all. Unsuccessful therapy could be either because the patient cannot withstand the treatment or because the type of leukaemia he/she is having is incurable.

Treatment methods available to cure the disease also carry a very high morbidity rate. This is because the drugs given to the patient can themselves harm the patient’s normal body cells in the process of killing the malignant cells. Therefore curative treatment is given only for those who have low risk (possibly curable) leukaemia.

Childhood Acute lymphoblastic Leukaemia is considered as low risk leukaemia and they are treated with curative intent. Even for them the treatment brings considerable morbidity. The morbidity is even more if the same treatment is given for the high risk groups. So, the physician will weigh the risks against benefits and offer the most suitable treatment option. 

Following leukaemias are considered as probably incurable 

1.      Acute myeloid leukaemia with adverse cytogenetic features in elderly

2.      Secondary acute myeloid leukaemia

3.      Recurrent acute leukaemias

References : Kumar P and Clark M, 2009. Clinical Medicine. 7th ed.