{"id":5235,"date":"2024-12-11T17:55:41","date_gmt":"2024-12-11T16:55:41","guid":{"rendered":"https:\/\/irccs.com\/patologie\/acute-leukemias\/"},"modified":"2026-06-23T12:04:39","modified_gmt":"2026-06-23T10:04:39","slug":"acute-leukemias","status":"publish","type":"pathology","link":"https:\/\/inoc.it\/en\/pathology\/acute-leukemias\/","title":{"rendered":"Acute Leukemias"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><span  id=\"pathology\" class=\"h2_anchor\"><\/span>Pathology<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Acute leukemias represent a heterogeneous group of blood cancers that arise from <strong>stem cells in the bone marrow<\/strong>. Under normal conditions, these cells give rise to <strong>red blood cells, white blood cells, and platelets<\/strong>, which are essential for life. In leukemia, however, stem cells lose the ability to mature and become immature cells called <strong>blasts<\/strong>. These blasts accumulate in the bone marrow and may circulate in the blood or spread to other organs.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The term <strong>leukemia<\/strong> comes from Greek and literally means <strong>\u201cwhite blood\u201d<\/strong>, referring to the presence of these immature cells in the bloodstream. For this reason, acute leukemias are also referred to as <strong>\u201cliquid\u201d tumors<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Acute leukemias can affect both <strong>adults and children<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Types<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Blasts can develop along two different maturation lineages: <strong>myeloid<\/strong> or <strong>lymphoid<\/strong>. Based on this, two main forms of acute leukemia are distinguished:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Acute Myeloid Leukemia (AML):<\/strong><br>There is an alteration in the development of stem cells of the <strong>myeloid lineage<\/strong>, which normally give rise to most white blood cells, as well as platelets and red blood cells. It accounts for approximately <strong>25% of all leukemias<\/strong> and about <strong>3% of all cancers<\/strong>. It is the most common form in adults, with higher incidence in people over <strong>65 years of age<\/strong>.<\/li>\n\n\n\n<li><strong>Acute Lymphoblastic Leukemia (ALL):<\/strong><br>The alteration affects the <strong>lymphoid lineage<\/strong>, from which <strong>B and T lymphocytes<\/strong>, essential for immune defense, derive. It accounts for approximately <strong>9.5% of all leukemias<\/strong>. It is the most common cancer in children, while it is less frequent in adults. Incidence is low after age 25, with a slight increase starting from age 50.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">The Numbers in Italy<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">According to the <a href=\"https:\/\/www.registri-tumori.it\/cms\/pubblicazioni\/i-numeri-del-cancro-italia-2023\"><strong>AIRTUM<\/strong> (Italian Association of Cancer Registries)<\/a>, leukemias and lymphomas account for about <strong>50% of all childhood cancers<\/strong>. In 2024, an estimated <strong>9,181 new leukemia diagnoses<\/strong> were recorded (5,408 men and 3,773 women).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"symptoms\" class=\"h2_anchor\"><\/span>Symptoms<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The most common sign suggesting acute leukemia is an <strong>alteration in blood cell counts<\/strong> detected by a simple blood test (<strong>complete blood count, CBC<\/strong>). However, the disease does not always produce clear symptoms: some patients may feel well, while others may present with non-specific complaints such as:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Persistent fever<\/li>\n\n\n\n<li>Bone pain<\/li>\n\n\n\n<li>Unexplained weight loss<\/li>\n\n\n\n<li>Unusual night sweats (less common)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In more advanced cases, symptoms may become more pronounced due to <strong><a href=\"https:\/\/inoc.it\/en\/medical-area\/hemopoietic-stem-cell-transplantation-and-cellular-therapies-center\/\">bone marrow dysfunction<\/a><\/strong>, which normally produces blood cells. These may include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Severe fatigue<\/strong> due to anemia (reduced red blood cells)<\/li>\n\n\n\n<li><strong>Easy bleeding or bruising<\/strong> due to low platelet counts<\/li>\n\n\n\n<li><strong>Increased susceptibility to infections<\/strong> due to altered white blood cells<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Leukemic cells may also accumulate in other organs of the immune system, leading to <strong>enlarged lymph nodes, liver, or spleen<\/strong>. When symptoms become significant, patients may present directly to the <strong>emergency department<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"risk-factors\" class=\"h2_anchor\"><\/span>Risk Factors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Having a risk factor does not mean that disease will develop, and in many cases no exact cause can be identified.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">In adults, the most relevant risk factors include:<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Age:<\/strong> risk increases particularly after 65 years<\/li>\n\n\n\n<li><strong>Cigarette smoking:<\/strong> exposure to carcinogens such as benzene<\/li>\n\n\n\n<li><strong>Prolonged exposure to chemicals:<\/strong> including solvents, pesticides, and benzene<\/li>\n\n\n\n<li><strong>Previous cancer treatments:<\/strong> certain chemotherapy or radiotherapy regimens<\/li>\n\n\n\n<li><strong>Ionizing radiation:<\/strong> high-dose exposure (environmental or therapeutic)<\/li>\n\n\n\n<li><strong>Pre-existing blood disorders:<\/strong> such as myelodysplastic syndromes<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">In children, relevant risk factors include:<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Genetic predisposition:<\/strong> for example, Down syndrome or Fanconi anemia<\/li>\n\n\n\n<li><strong>Rare hereditary syndromes:<\/strong> associated with increased cellular susceptibility to mutations<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"diagnosis-and-examination\" class=\"h2_anchor\"><\/span>Diagnosis and Examination<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnostic pathway of acute leukemia may begin in different ways. In some cases, it is suspected following a routine blood test; in others, symptoms lead the patient to a general practitioner or directly to the emergency department.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When leukemia is suspected, it is essential to promptly refer the patient to a <strong>specialist hematologist-oncologist<\/strong>. This allows rapid stabilization of the clinical condition and timely performance of diagnostic tests required to initiate appropriate therapy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Diagnosis is based primarily on <strong>peripheral blood analysis<\/strong> and <strong>bone marrow examination<\/strong>, which allow detection of leukemic cells and characterization of their features.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Unlike other cancers, acute leukemias do not require staging because they are <strong>systemic (\u201cliquid\u201d) tumors affecting blood and bone marrow from the outset<\/strong>. Instead, defining the <strong>prognostic risk category<\/strong> is essential, as it guides the selection of the most appropriate and individualized treatment strategy for each patient.<\/p>\n\n\n\t<div id=\"block_6a3a5a3501c09\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Blood Tests<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"155\" data-end=\"358\">Blood tests are a critical first step in confirming suspicion of <strong data-start=\"220\" data-end=\"238\">acute leukemia<\/strong> and, more importantly, in assessing whether the patient is in a condition that may rapidly become <strong data-start=\"337\" data-end=\"357\">life-threatening<\/strong>.<\/p>\n<p data-start=\"360\" data-end=\"403\">In particular, the following are evaluated:<\/p>\n<ul data-start=\"405\" data-end=\"689\">\n<li data-section-id=\"6cp5qf\" data-start=\"405\" data-end=\"602\"><strong data-start=\"407\" data-end=\"438\">Complete blood count (CBC):<\/strong> to assess <strong data-start=\"449\" data-end=\"459\">anemia<\/strong> (reduced red blood cells), abnormalities in <strong data-start=\"504\" data-end=\"525\">white blood cells<\/strong> (which may be either decreased or increased), and <strong data-start=\"576\" data-end=\"599\">low platelet counts<\/strong>.<\/li>\n<li data-section-id=\"itil2x\" data-start=\"603\" data-end=\"689\"><strong data-start=\"605\" data-end=\"632\">Coagulation parameters:<\/strong> to detect any <strong data-start=\"647\" data-end=\"688\">clotting abnormalities (coagulopathy)<\/strong>.<\/li>\n<\/ul>\n<p data-start=\"691\" data-end=\"1007\">These findings allow physicians to rapidly determine whether <strong data-start=\"752\" data-end=\"784\">urgent supportive treatments<\/strong> are required, such as transfusions of <strong data-start=\"823\" data-end=\"864\">red blood cells, platelets, or plasma<\/strong>. These interventions can be <strong data-start=\"893\" data-end=\"908\">life-saving<\/strong> and help stabilize the patient while further diagnostic tests and specific treatment are arranged.<\/p>\n<p data-start=\"1009\" data-end=\"1347\">Some forms of acute leukemia require particularly urgent diagnosis and management. Among these is <strong data-start=\"1107\" data-end=\"1145\">acute promyelocytic leukemia (APL)<\/strong>, a rare subtype associated in its early stages with a <strong data-start=\"1200\" data-end=\"1258\">very high risk of severe, potentially fatal hemorrhage<\/strong>. However, if recognized and treated promptly, <strong data-start=\"1305\" data-end=\"1346\">APL is a potentially curable leukemia<\/strong>.<\/p>\n<p data-start=\"1349\" data-end=\"1494\">For this reason, it must be suspected and confirmed as quickly as possible in patients with <strong data-start=\"1441\" data-end=\"1493\">abnormal blood counts and coagulation parameters<\/strong>.<\/p>\n<p data-start=\"1496\" data-end=\"1557\">The specialist may also request additional tests to evaluate:<\/p>\n<ul data-start=\"1559\" data-end=\"1844\" data-is-last-node=\"\" data-is-only-node=\"\">\n<li data-section-id=\"11hnxem\" data-start=\"1559\" data-end=\"1637\"><strong data-start=\"1561\" data-end=\"1590\">Kidney and liver function<\/strong>, which are essential for treatment tolerance<\/li>\n<li data-section-id=\"6rxeep\" data-start=\"1638\" data-end=\"1844\" data-is-last-node=\"\">Blood levels of substances such as <strong data-start=\"1675\" data-end=\"1706\">lactate dehydrogenase (LDH)<\/strong> and <strong data-start=\"1711\" data-end=\"1724\">uric acid<\/strong>, which provide information about <strong data-start=\"1758\" data-end=\"1795\">disease activity and tumor burden<\/strong>, as well as possible involvement of other organs<\/li>\n<\/ul>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Smear and Immunophenotyping on Peripheral Blood<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"56\" data-end=\"302\">Even today, <strong data-start=\"68\" data-end=\"88\">light microscopy<\/strong> remains one of the main tools for the diagnosis and classification of <strong data-start=\"159\" data-end=\"178\">acute leukemias<\/strong>. The primary objective is to identify <strong data-start=\"217\" data-end=\"227\">blasts<\/strong>, the immature cells characteristic of the disease, in the patient\u2019s blood.<\/p>\n<h3 data-section-id=\"1hgcmiz\" data-start=\"304\" data-end=\"357\"><span role=\"text\"><strong data-start=\"308\" data-end=\"355\">Cytomorphological examination (blood smear)<\/strong><\/span><\/h3>\n<p data-start=\"358\" data-end=\"613\">After a simple blood draw, a small sample is spread onto a slide. The slide is then stained with special reagents and examined under a <strong data-start=\"493\" data-end=\"513\">light microscope<\/strong>. This allows direct visualization of <strong data-start=\"551\" data-end=\"569\">leukemic cells<\/strong> and assessment of their <strong data-start=\"594\" data-end=\"612\">shape and size<\/strong>.<\/p>\n<h3 data-section-id=\"12t98vb\" data-start=\"615\" data-end=\"672\"><span role=\"text\"><strong data-start=\"619\" data-end=\"670\">Flow cytometric examination (immunophenotyping)<\/strong><\/span><\/h3>\n<p data-start=\"673\" data-end=\"861\">This test analyzes the <strong data-start=\"696\" data-end=\"743\">proteins expressed on the surface of blasts<\/strong>. It uses specific antibodies that bind to these proteins and makes them detectable through specialized instruments.<\/p>\n<p data-start=\"863\" data-end=\"1042\" data-is-last-node=\"\" data-is-only-node=\"\">Immunophenotyping helps determine the <strong data-start=\"901\" data-end=\"921\">type of leukemia<\/strong> (lymphoblastic or myeloid) and provides essential information for selecting the most appropriate <strong data-start=\"1019\" data-end=\"1041\">treatment strategy<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Needle Aspiration and Bone Marrow Biopsy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"49\" data-end=\"345\">In both forms of acute leukemia (<strong data-start=\"82\" data-end=\"89\">AML<\/strong> and <strong data-start=\"94\" data-end=\"101\">ALL<\/strong>), multiple subtypes can be identified, each with different clinical features and prognoses that must be considered when planning treatment. This requires a detailed examination of the <strong data-start=\"286\" data-end=\"301\">bone marrow<\/strong>, with the aim of characterizing <strong data-start=\"334\" data-end=\"344\">blasts<\/strong>.<\/p>\n<p data-start=\"347\" data-end=\"665\">The procedure is performed under <strong data-start=\"380\" data-end=\"400\">local anesthesia<\/strong>. The physician inserts a needle into the <strong data-start=\"442\" data-end=\"473\">upper posterior iliac crest<\/strong>, allowing access to the pelvic bone to aspirate a small sample of bone marrow. If aspiration is not possible (<strong data-start=\"584\" data-end=\"595\">dry tap<\/strong>, or <em data-start=\"600\" data-end=\"615\">punctio sicca<\/em>), a small core of bone marrow tissue is obtained.<\/p>\n<p data-start=\"667\" data-end=\"744\">The collected material is then sent to the pathology laboratory for analysis:<\/p>\n<ul data-start=\"746\" data-end=\"1709\">\n<li data-section-id=\"18aihsr\" data-start=\"746\" data-end=\"926\"><strong data-start=\"748\" data-end=\"782\">Cytomorphological examination:<\/strong> as with peripheral blood, a smear is prepared on a slide, stained, and examined under a microscope to evaluate the morphology of blast cells.<\/li>\n<li data-section-id=\"yuj7ag\" data-start=\"927\" data-end=\"1128\"><strong data-start=\"929\" data-end=\"968\">Flow cytometry (immunophenotyping):<\/strong> identifies the expression of specific surface antigens using monoclonal antibodies, enabling an initial classification of acute leukemia into <strong data-start=\"1111\" data-end=\"1125\">AML or ALL<\/strong>.<\/li>\n<li data-section-id=\"1sdzjyr\" data-start=\"1129\" data-end=\"1600\"><strong data-start=\"1131\" data-end=\"1156\">Cytogenetic analysis:<\/strong> studies chromosomal abnormalities in blast cells through karyotype analysis or targeted techniques such as <strong data-start=\"1264\" data-end=\"1309\">FISH (fluorescence in situ hybridization)<\/strong>, which detects specific DNA alterations using fluorescent probes. This approach allows rapid identification of key genetic lesions, such as those seen in <strong data-start=\"1464\" data-end=\"1502\">acute promyelocytic leukemia (APL)<\/strong> or the <strong data-start=\"1510\" data-end=\"1537\">Philadelphia chromosome<\/strong>, present mainly in some forms of ALL and more rarely in AML.<\/li>\n<li data-section-id=\"awcqey\" data-start=\"1601\" data-end=\"1709\"><strong data-start=\"1603\" data-end=\"1631\">Molecular biology tests:<\/strong> identify specific genetic alterations at the DNA or RNA level in blast cells.<\/li>\n<\/ul>\n<p data-start=\"1711\" data-end=\"2085\">In acute leukemias, specific genetic and molecular abnormalities are often associated with particular cellular features observed under the microscope or through immunophenotyping. This information is essential to <strong data-start=\"1924\" data-end=\"1949\">confirm the diagnosis<\/strong>, identify the exact leukemia subtype, define <strong data-start=\"1995\" data-end=\"2026\">prognosis and risk category<\/strong>, and select the most appropriate and personalized therapy.<\/p>\n<p data-start=\"2087\" data-end=\"2287\">Some of these alterations also represent targets for <strong data-start=\"2140\" data-end=\"2162\">targeted therapies<\/strong> and are used to monitor <strong data-start=\"2187\" data-end=\"2221\">minimal residual disease (MRD)<\/strong>, meaning the presence of residual leukemic cells after treatment.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Lumbar Puncture (Rachicentesis)<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"40\" data-end=\"286\">Acute leukemias are <strong data-start=\"60\" data-end=\"81\">systemic diseases<\/strong>, as blasts, in addition to involving the bone marrow and blood, can circulate and infiltrate other organs and tissues, including <strong data-start=\"211\" data-end=\"249\">lymph nodes, spleen, liver, testes<\/strong>, and the <strong data-start=\"259\" data-end=\"285\">central nervous system<\/strong>.<\/p>\n<p data-start=\"288\" data-end=\"535\">When blasts cross the <strong data-start=\"310\" data-end=\"339\">blood-brain barrier (BBB)<\/strong>, the natural protective barrier of the brain and spinal cord, they may enter the <strong data-start=\"421\" data-end=\"450\">cerebrospinal fluid (CSF)<\/strong> that surrounds and nourishes the nervous system, leading to <strong data-start=\"511\" data-end=\"534\">leukemic meningosis<\/strong>.<\/p>\n<p data-start=\"288\" data-end=\"535\"><span role=\"text\"><strong data-start=\"545\" data-end=\"589\">Assessment of Nervous System Involvement<\/strong><\/span><\/p>\n<p data-start=\"591\" data-end=\"740\">The presence of leukemia in the central nervous system is evaluated through a <strong data-start=\"669\" data-end=\"701\">lumbar puncture (spinal tap)<\/strong>, performed under <strong data-start=\"719\" data-end=\"739\">local anesthesia<\/strong>:<\/p>\n<ul data-start=\"742\" data-end=\"1072\">\n<li data-section-id=\"o866u\" data-start=\"742\" data-end=\"869\">A needle is inserted into the space between two lumbar vertebrae to collect a small sample of <strong data-start=\"838\" data-end=\"867\">cerebrospinal fluid (CSF)<\/strong><\/li>\n<li data-section-id=\"rok3g0\" data-start=\"870\" data-end=\"1072\">The CSF is then analyzed using:\n<ul data-start=\"906\" data-end=\"1072\">\n<li data-section-id=\"iyqvpx\" data-start=\"906\" data-end=\"984\"><strong data-start=\"908\" data-end=\"935\">Cytological examination<\/strong>, to detect abnormal cells under the microscope<\/li>\n<li data-section-id=\"3t0f2r\" data-start=\"987\" data-end=\"1072\"><strong data-start=\"989\" data-end=\"1010\">Immunophenotyping<\/strong>, to identify surface proteins characteristic of blast cells<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p data-start=\"1079\" data-end=\"1261\" data-is-last-node=\"\" data-is-only-node=\"\">This assessment is essential to guide the most appropriate and targeted <strong data-start=\"1151\" data-end=\"1175\">therapeutic strategy<\/strong> and to ensure adequate protection of the <strong data-start=\"1217\" data-end=\"1243\">central nervous system<\/strong> during treatment.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Radiological and Instrumental Examinations<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"51\" data-end=\"151\">Rarely, acute leukemia may present with a <strong data-start=\"93\" data-end=\"125\">mass outside the bone marrow<\/strong> (extramedullary disease).<\/p>\n<p data-start=\"153\" data-end=\"261\">In <strong data-start=\"156\" data-end=\"194\">ALL (acute lymphoblastic leukemia)<\/strong>, blasts may infiltrate the <strong data-start=\"222\" data-end=\"260\">lymphoid tissues of various organs<\/strong>.<\/p>\n<p data-start=\"263\" data-end=\"348\">In <strong data-start=\"266\" data-end=\"298\">AML (acute myeloid leukemia)<\/strong>, this solid form is known as <strong data-start=\"328\" data-end=\"347\">myeloid sarcoma<\/strong>.<\/p>\n<p data-start=\"350\" data-end=\"522\">To assess possible involvement of other organs of the immune system (such as <strong data-start=\"427\" data-end=\"461\">liver, spleen, and lymph nodes<\/strong>) or other tissues, the following examinations may be useful:<\/p>\n<ol data-start=\"524\" data-end=\"1475\">\n<li data-section-id=\"k9yown\" data-start=\"524\" data-end=\"764\"><strong data-start=\"526\" data-end=\"551\">Abdominal ultrasound:<\/strong> a radiation-free imaging technique based on ultrasound waves. It can detect <strong data-start=\"628\" data-end=\"644\">splenomegaly<\/strong>, <strong data-start=\"646\" data-end=\"662\">hepatomegaly<\/strong>, or enlarged deep lymph nodes. It is performed on an <strong data-start=\"716\" data-end=\"733\">empty stomach<\/strong> in the radiology department.<\/li>\n<li data-section-id=\"nwgm6d\" data-start=\"765\" data-end=\"944\"><strong data-start=\"767\" data-end=\"793\">Testicular ultrasound:<\/strong> indicated in male patients with ALL, used to evaluate possible infiltration of the testes due to crossing of the <strong data-start=\"907\" data-end=\"931\">blood-testis barrier<\/strong> by blasts.<\/li>\n<li data-section-id=\"tnedoz\" data-start=\"945\" data-end=\"1246\"><strong data-start=\"947\" data-end=\"981\">CT (computed tomography) scan:<\/strong> a radiological technique that produces <strong data-start=\"1021\" data-end=\"1049\">three-dimensional images<\/strong> of organs and tissues. A <strong data-start=\"1075\" data-end=\"1097\">total-body CT scan<\/strong> (head, neck, chest, abdomen, and pelvis) can identify lymph node enlargement or tumor masses. It requires <strong data-start=\"1204\" data-end=\"1243\">intravenous contrast administration<\/strong>.<\/li>\n<li data-section-id=\"46wqg7\" data-start=\"1247\" data-end=\"1475\"><strong data-start=\"1249\" data-end=\"1293\">PET (positron emission tomography) scan:<\/strong> less commonly used in acute leukemias, it detects tumor activity based on <strong data-start=\"1368\" data-end=\"1400\">increased glucose metabolism<\/strong> using a radiolabeled tracer. It may be useful in selected subtypes of ALL.<\/li>\n<\/ol>\n<p><strong data-start=\"1485\" data-end=\"1519\">Assessment of Cardiac Function<\/strong><\/p>\n<p data-start=\"1521\" data-end=\"1784\" data-is-last-node=\"\" data-is-only-node=\"\">Some drugs used in the treatment of acute leukemia may affect the <strong data-start=\"1587\" data-end=\"1596\">heart<\/strong>. For this reason, a <strong data-start=\"1617\" data-end=\"1664\">cardiological evaluation and echocardiogram<\/strong> are essential to assess cardiac function and ensure that therapy is planned in the safest possible way for the patient.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Prognostic Evaluation<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"30\" data-end=\"228\">In acute leukemias, clinicians assess a series of internationally recognized <strong data-start=\"107\" data-end=\"129\">prognostic factors<\/strong>. These factors help estimate the likelihood of <strong data-start=\"177\" data-end=\"202\">response to treatment<\/strong> and overall <strong data-start=\"215\" data-end=\"227\">survival<\/strong>.<\/p>\n<p data-start=\"230\" data-end=\"267\">The main elements considered include:<\/p>\n<ul data-start=\"269\" data-end=\"580\">\n<li data-section-id=\"8ptvcq\" data-start=\"269\" data-end=\"399\"><strong data-start=\"271\" data-end=\"293\">Extent of disease:<\/strong> for example, the presence of <strong data-start=\"323\" data-end=\"348\">extramedullary masses<\/strong> or involvement of the <strong data-start=\"371\" data-end=\"397\">central nervous system<\/strong><\/li>\n<li data-section-id=\"vqov2i\" data-start=\"400\" data-end=\"490\"><strong data-start=\"402\" data-end=\"437\">Cytogenetic and molecular data:<\/strong> genetic abnormalities identified in leukemic cells<\/li>\n<li data-section-id=\"1hv5556\" data-start=\"491\" data-end=\"580\"><strong data-start=\"493\" data-end=\"528\">Dynamic hematologic parameters:<\/strong> evaluation of the <strong data-start=\"547\" data-end=\"578\">initial response to therapy<\/strong><\/li>\n<\/ul>\n<p data-start=\"582\" data-end=\"699\">Based on these variables, patients are stratified into <strong data-start=\"637\" data-end=\"656\">risk categories<\/strong>: <strong data-start=\"658\" data-end=\"698\">standard, intermediate, or high risk<\/strong>.<\/p>\n<p data-start=\"701\" data-end=\"881\" data-is-last-node=\"\" data-is-only-node=\"\">This classification allows clinicians to assess the <strong data-start=\"753\" data-end=\"786\">aggressiveness of the disease<\/strong> and to select the most appropriate and individualized <strong data-start=\"841\" data-end=\"863\">treatment strategy<\/strong> for each patient.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"therapies\" class=\"h2_anchor\"><\/span>Therapies<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">After diagnosis, the <a href=\"https:\/\/inoc.it\/en\/pathology\/acute-leukemias\/#multi-disciplinary-team\"><strong>Multidisciplinary Team<\/strong> <\/a>evaluates all relevant patient factors, including <strong>leukemia type, disease aggressiveness, age, and general health status<\/strong>, to define an <strong>individualized treatment plan<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Therapies for acute leukemia may include <strong>chemotherapy<\/strong>, <strong>molecularly targeted drugs<\/strong>, <strong>immunotherapies<\/strong>, <strong>hypomethylating agents<\/strong>, and, in selected cases, <strong>hematopoietic stem cell transplantation<\/strong>. Participation in <strong>experimental clinical trials<\/strong> conducted by the Institute\u2019s researchers may also be considered. When appropriate, this option is presented to the patient and discussed within a <strong>shared decision-making process<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In some subtypes, particularly <strong>ALL<\/strong>, blasts may reach the <strong>central nervous system<\/strong>. For this reason, <strong>meningeal prophylaxis<\/strong> is performed via <strong>lumbar puncture<\/strong>, with the administration of <strong>chemotherapeutic agents into the cerebrospinal fluid<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In addition to disease-specific therapy, <strong>supportive care<\/strong> is essential to stabilize the patient\u2019s clinical condition, reduce complications related to the disease, and manage the <strong>toxic effects of treatment<\/strong>.<\/p>\n\n\n\t<div id=\"block_6a3a5a3501d5b\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Chemotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<div class=\"qMYqUG_convSearchResultHighlightRoot\">\n<div class=\"\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-53\" data-is-intersecting=\"true\">\n<section class=\"text-token-text-primary w-full focus:outline-none has-data-writing-block:pointer-events-none [&amp;:has([data-writing-block])&gt;*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]\" dir=\"auto\" data-turn-id=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-53\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-53\" data-testid=\"conversation-turn-108\" data-scroll-anchor=\"false\" data-turn=\"assistant\">\n<div class=\"text-base my-auto mx-auto pb-10 [--thread-content-margin:var(--thread-content-margin-xs,calc(var(--spacing)*4))] @w-sm\/main:[--thread-content-margin:var(--thread-content-margin-sm,calc(var(--spacing)*6))] @w-lg\/main:[--thread-content-margin:var(--thread-content-margin-lg,calc(var(--spacing)*16))] px-(--thread-content-margin)\">\n<div class=\"[--thread-content-max-width:40rem] @w-lg\/main:[--thread-content-max-width:48rem] mx-auto max-w-(--thread-content-max-width) flex-1 group\/turn-messages focus-visible:outline-hidden relative flex w-full min-w-0 flex-col agent-turn\" data-conversation-screenshot-content=\"\">\n<div class=\"flex max-w-full flex-col gap-4 grow\">\n<div class=\"min-h-8 text-message relative flex w-full flex-col items-end gap-2 text-start break-words whitespace-normal outline-none keyboard-focused:focus-ring [.text-message+&amp;]:mt-1\" dir=\"auto\" tabindex=\"0\" data-message-author-role=\"assistant\" data-message-id=\"d870361e-bc89-4d63-a7b9-a16d5228ba6b\" data-message-model-slug=\"gpt-5-3-mini\" data-turn-start-message=\"true\">\n<div class=\"flex w-full flex-col gap-1 empty:hidden\">\n<div class=\"markdown prose dark:prose-invert wrap-break-word w-full light markdown-new-styling\">\n<p data-start=\"166\" data-end=\"687\">The term <strong data-start=\"175\" data-end=\"191\">chemotherapy<\/strong> refers to drugs that eliminate cancer cells by exploiting their <strong data-start=\"256\" data-end=\"314\">faster rate of proliferation compared to healthy cells<\/strong>. Because these treatments interfere with <strong data-start=\"356\" data-end=\"387\">cell replication mechanisms<\/strong>, they can also damage normal cells in the body, leading to side effects. These are often <strong data-start=\"477\" data-end=\"490\">temporary<\/strong>, usually resolving after treatment, and can be effectively managed with <strong data-start=\"563\" data-end=\"587\">supportive therapies<\/strong>, such as treatment for <strong data-start=\"611\" data-end=\"624\">mucositis<\/strong> (inflammation of the mucous membranes of the digestive tract).<\/p>\n<p data-start=\"689\" data-end=\"848\">Patients under the age of <strong data-start=\"715\" data-end=\"727\">65 years<\/strong>, without significant comorbidities, are generally considered <strong data-start=\"789\" data-end=\"799\">\u201cfit,\u201d<\/strong> meaning suitable for <strong data-start=\"821\" data-end=\"847\">intensive chemotherapy<\/strong>.<\/p>\n<p data-start=\"850\" data-end=\"1266\">In most cases, chemotherapy is administered <strong data-start=\"894\" data-end=\"911\">intravenously<\/strong>. For this reason, the placement of a <strong data-start=\"949\" data-end=\"982\">central venous catheter (CVC)<\/strong> is often required, inserted into a large vein such as the <strong data-start=\"1041\" data-end=\"1071\">subclavian or jugular vein<\/strong>. The duration of each administration, performed in an <strong data-start=\"1126\" data-end=\"1163\">inpatient or day-hospital setting<\/strong> depending on the treatment regimen and drug combinations, may range from <strong data-start=\"1237\" data-end=\"1265\">minutes to several hours<\/strong>.<\/p>\n<p data-start=\"1268\" data-end=\"1578\">Chemotherapy is administered in <strong data-start=\"1300\" data-end=\"1310\">cycles<\/strong>. Each cycle may last one or several days and is followed by a <strong data-start=\"1373\" data-end=\"1405\">rest period of several weeks<\/strong>. The total number of cycles depends on the <strong data-start=\"1449\" data-end=\"1475\">type of acute leukemia<\/strong> and the <strong data-start=\"1484\" data-end=\"1509\">response to treatment<\/strong>, which can vary significantly between patients and disease subtypes.<\/p>\n<p data-start=\"1580\" data-end=\"1892\" data-is-last-node=\"\" data-is-only-node=\"\">After chemotherapy, blood cell counts, including <strong data-start=\"1629\" data-end=\"1682\">white blood cells, platelets, and red blood cells<\/strong>, may fall to very low levels, a phase known as <strong data-start=\"1730\" data-end=\"1741\">aplasia<\/strong>. During this period, the patient is at increased risk of <strong data-start=\"1799\" data-end=\"1834\">serious infections and bleeding<\/strong>, often requiring <strong data-start=\"1852\" data-end=\"1891\">supportive care and hospitalization<\/strong>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Molecularly Targeted Drugs<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"35\" data-end=\"244\">These are drugs capable of blocking specific <strong data-start=\"80\" data-end=\"105\">molecular alterations<\/strong> that drive the growth of certain types of acute leukemias, such as <strong data-start=\"173\" data-end=\"196\">FLT3 gene mutations<\/strong> and <strong data-start=\"201\" data-end=\"222\">BCL-2 alterations<\/strong> in some forms of AML.<\/p>\n<p data-start=\"246\" data-end=\"415\">These medications are administered <strong data-start=\"281\" data-end=\"291\">orally<\/strong> and are usually taken on a <strong data-start=\"319\" data-end=\"339\">continuous basis<\/strong>. Examples include <strong data-start=\"358\" data-end=\"414\">Midostaurin, Gilteritinib, Venetoclax, and Glasdegib<\/strong>.<\/p>\n<p data-start=\"417\" data-end=\"941\">The use of these \u201cbiologic\u201d therapies, either in combination with standard chemotherapy or as a substitute for it, depends on the <strong data-start=\"547\" data-end=\"576\">subtype of acute leukemia<\/strong> and the patient\u2019s <strong data-start=\"595\" data-end=\"618\">risk classification<\/strong>. These strategies have demonstrated benefits in terms of <strong data-start=\"676\" data-end=\"707\">response rates and survival<\/strong>, and can lead to highly specific treatment approaches, such as the use of <strong data-start=\"782\" data-end=\"816\">all-trans retinoic acid (ATRA)<\/strong> and <strong data-start=\"821\" data-end=\"847\">arsenic trioxide (ATO)<\/strong> in <strong data-start=\"851\" data-end=\"858\">APL<\/strong>, allowing in some cases the disease to be cured without conventional chemotherapy.<\/p>\n<p data-start=\"943\" data-end=\"1366\" data-is-last-node=\"\" data-is-only-node=\"\">Finally, in some forms of <strong data-start=\"969\" data-end=\"976\">ALL<\/strong> characterized by the <strong data-start=\"998\" data-end=\"1025\">Philadelphia chromosome<\/strong>, which leads to the formation of the oncogenic protein <strong data-start=\"1081\" data-end=\"1092\">BCR-ABL<\/strong>, <strong data-start=\"1094\" data-end=\"1124\">tyrosine kinase inhibitors<\/strong> such as <strong data-start=\"1133\" data-end=\"1159\">Imatinib and Dasatinib<\/strong> are used, often in combination with steroids alone. This approach allows <strong data-start=\"1233\" data-end=\"1280\">complete remission in the majority of cases<\/strong> while significantly reducing the toxic effects associated with standard chemotherapy.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Immunotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"22\" data-end=\"214\"><strong data-start=\"22\" data-end=\"39\">Immunotherapy<\/strong> uses drugs that restore the immune system\u2019s ability to recognize and destroy cancer cells. In patients with acute leukemia, these agents are mainly <strong data-start=\"188\" data-end=\"213\">monoclonal antibodies<\/strong>.<\/p>\n<p data-start=\"216\" data-end=\"405\">Monoclonal antibodies act similarly to the body\u2019s natural antibodies, binding to specific receptors on leukemia cells and promoting their elimination by the immune system. Examples include:<\/p>\n<ul data-start=\"407\" data-end=\"559\">\n<li data-section-id=\"196o59r\" data-start=\"407\" data-end=\"479\"><strong data-start=\"409\" data-end=\"434\">Gemtuzumab ozogamicin<\/strong>, which targets the <strong data-start=\"454\" data-end=\"470\">CD33 antigen<\/strong> in AML<\/li>\n<li data-section-id=\"n88v5s\" data-start=\"480\" data-end=\"559\"><strong data-start=\"482\" data-end=\"507\">Inotuzumab ozogamicin<\/strong>, which targets the <strong data-start=\"527\" data-end=\"543\">CD22 antigen<\/strong> in B-cell ALL<\/li>\n<\/ul>\n<p data-start=\"561\" data-end=\"912\">Some antibodies, known as <strong data-start=\"587\" data-end=\"612\">bispecific antibodies<\/strong>, have a dual mechanism of action: they bind to leukemia blasts and simultaneously activate the patient\u2019s <strong data-start=\"718\" data-end=\"735\">T lymphocytes<\/strong>, enabling them to attack cancer cells. An example is <strong data-start=\"789\" data-end=\"805\">Blinatumomab<\/strong>, which binds <strong data-start=\"819\" data-end=\"837\">CD19 on blasts<\/strong> and <strong data-start=\"842\" data-end=\"860\">CD3 on T cells<\/strong>, promoting selective destruction of leukemic cells.<\/p>\n<p data-start=\"914\" data-end=\"1030\">Monoclonal antibodies may be used alone or in combination with <strong data-start=\"977\" data-end=\"993\">chemotherapy<\/strong>, increasing treatment effectiveness.<\/p>\n<p data-start=\"1032\" data-end=\"1522\" data-is-last-node=\"\" data-is-only-node=\"\">Finally, in particularly aggressive or treatment-resistant forms of <strong data-start=\"1100\" data-end=\"1114\">B-cell ALL<\/strong>, <strong data-start=\"1116\" data-end=\"1138\">CAR T-cell therapy<\/strong> may be used. This involves collecting the patient\u2019s <strong data-start=\"1191\" data-end=\"1208\">T lymphocytes<\/strong>, genetically modifying them in the laboratory to recognize the <strong data-start=\"1272\" data-end=\"1288\">CD19 antigen<\/strong> on leukemia cells, and reinfusing them to selectively attack the tumor. This therapy is reserved for selected patients, generally up to <strong data-start=\"1425\" data-end=\"1444\">25 years of age<\/strong>, and requires careful monitoring due to the risk of <strong data-start=\"1497\" data-end=\"1521\">serious side effects<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Hypomethylating Agents<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"31\" data-end=\"476\">In elderly patients (generally over <strong data-start=\"67\" data-end=\"92\">65 to 70 years of age<\/strong>) or in those who are <strong data-start=\"114\" data-end=\"134\">clinically frail<\/strong> due to comorbidities (often defined in oncology as \u201cunfit\u201d), as well as in patients with <strong data-start=\"224\" data-end=\"261\">unfavorable genetic abnormalities<\/strong> associated with poor response to conventional chemotherapy, a <strong data-start=\"324\" data-end=\"363\">less intensive therapeutic approach<\/strong> may be considered. The goal is <strong data-start=\"395\" data-end=\"414\">disease control<\/strong> while avoiding potentially severe treatment-related toxicity.<\/p>\n<p data-start=\"478\" data-end=\"980\">This strategy is based on <strong data-start=\"504\" data-end=\"530\">hypomethylating agents<\/strong>, such as <strong data-start=\"540\" data-end=\"557\">5-azacytidine<\/strong> and <strong data-start=\"562\" data-end=\"576\">decitabine<\/strong>, which act on an epigenetic process known as <strong data-start=\"622\" data-end=\"646\">DNA hypermethylation<\/strong>. This mechanism can silence genes that are important for regulating normal cellular behavior, including <strong data-start=\"751\" data-end=\"777\">tumor suppressor genes<\/strong>, thereby contributing to malignant transformation. Because these changes do not involve alterations in the DNA sequence, they are <strong data-start=\"908\" data-end=\"934\">potentially reversible<\/strong> and therefore represent a therapeutic target.<\/p>\n<p data-start=\"982\" data-end=\"1156\">These drugs inhibit the enzymes responsible for <strong data-start=\"1030\" data-end=\"1049\">DNA methylation<\/strong>, thereby helping to restore normal gene activity and <strong data-start=\"1103\" data-end=\"1138\">reactivate antitumor mechanisms<\/strong> within the cells.<\/p>\n<p data-start=\"1158\" data-end=\"1541\" data-is-last-node=\"\" data-is-only-node=\"\">With these therapies, it is possible to achieve a meaningful proportion of <strong data-start=\"1233\" data-end=\"1256\">complete remissions<\/strong>, as well as <strong data-start=\"1269\" data-end=\"1294\">disease stabilization<\/strong> and improvement in <strong data-start=\"1314\" data-end=\"1336\">blood count values<\/strong> and <strong data-start=\"1341\" data-end=\"1377\">reduced transfusion requirements<\/strong>. This approach helps avoid further clinical deterioration in fragile patients and limits exposure to intensive therapies that would not provide a survival benefit.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Supportive Therapies<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"29\" data-end=\"152\">Alongside specific treatment for acute leukemia, <strong data-start=\"78\" data-end=\"100\">supportive therapy<\/strong> plays an essential role and can be <strong data-start=\"136\" data-end=\"151\">life-saving<\/strong>.<\/p>\n<p data-start=\"154\" data-end=\"166\">It includes:<\/p>\n<ul data-start=\"168\" data-end=\"929\">\n<li data-section-id=\"1sh1ao0\" data-start=\"168\" data-end=\"314\"><strong data-start=\"170\" data-end=\"206\">Transfusions of blood components<\/strong> (red blood cells, platelets, and plasma) to prevent bleeding complications and cardiovascular instability<\/li>\n<li data-section-id=\"10o457j\" data-start=\"315\" data-end=\"420\"><strong data-start=\"317\" data-end=\"349\">Hematopoietic growth factors<\/strong> to improve blood counts and reduce the risk of anemia and infections<\/li>\n<li data-section-id=\"1urq6zj\" data-start=\"421\" data-end=\"563\"><strong data-start=\"423\" data-end=\"445\">Adequate hydration<\/strong> to prevent <strong data-start=\"457\" data-end=\"481\">tumor lysis syndrome<\/strong>, which results from the rapid release of toxic substances from destroyed blasts<\/li>\n<li data-section-id=\"1b9kgyd\" data-start=\"564\" data-end=\"692\"><strong data-start=\"566\" data-end=\"591\">Antimicrobial therapy<\/strong> (antibiotics, antifungals, antivirals) to prevent or treat infections due to <strong data-start=\"669\" data-end=\"690\">immunosuppression<\/strong><\/li>\n<li data-section-id=\"qvyemd\" data-start=\"693\" data-end=\"806\"><strong data-start=\"695\" data-end=\"719\">Parenteral nutrition<\/strong>, when necessary, in cases of weight loss or reduced oral intake due to <strong data-start=\"791\" data-end=\"804\">mucositis<\/strong><\/li>\n<li data-section-id=\"10el3vb\" data-start=\"807\" data-end=\"929\"><strong data-start=\"809\" data-end=\"836\">Pain management therapy<\/strong> to relieve bone pain or gastrointestinal discomfort caused by the disease or its treatment<\/li>\n<\/ul>\n<p data-start=\"931\" data-end=\"1080\" data-is-last-node=\"\" data-is-only-node=\"\">This supportive care is essential to maintain <strong data-start=\"977\" data-end=\"999\">clinical stability<\/strong>, reduce complications, and improve tolerance to <strong data-start=\"1048\" data-end=\"1079\">leukemia-specific therapies<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Stem Cell Transplantation<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"34\" data-end=\"365\">Acute leukemias with a <strong data-start=\"57\" data-end=\"80\">favorable prognosis<\/strong> that respond well to drug therapy usually do not require <a href=\"https:\/\/inoc.it\/en\/medical-area\/hemopoietic-stem-cell-transplantation-and-cellular-therapies-center\/\"><strong data-start=\"138\" data-end=\"187\">hematopoietic stem cell (HSC) transplantation<\/strong>.<\/a> This procedure is generally considered only in cases of <strong data-start=\"245\" data-end=\"273\">relapse during treatment<\/strong>, or when there is an <strong data-start=\"295\" data-end=\"364\">incomplete response or resistance to therapy (refractory disease)<\/strong>.<\/p>\n<p data-start=\"367\" data-end=\"952\"><strong data-start=\"367\" data-end=\"401\">Allogeneic HSC transplantation<\/strong>, in which stem cells are obtained from a <strong data-start=\"443\" data-end=\"463\">compatible donor<\/strong> (related or unrelated), is an effective strategy to improve long-term survival in patients with <strong data-start=\"560\" data-end=\"605\">intermediate- or high-risk acute leukemia<\/strong>, as well as in <strong data-start=\"621\" data-end=\"653\" data-is-only-node=\"\">relapsed or refractory cases<\/strong>. The transplanted cells restore normal bone marrow function and support the immune system in eliminating any residual leukemia cells. Before transplantation, achieving a <strong data-start=\"824\" data-end=\"865\">good response to initial drug therapy<\/strong> is essential to increase the likelihood of success and reduce treatment-related risks.<\/p>\n<p data-start=\"954\" data-end=\"1135\" data-is-last-node=\"\" data-is-only-node=\"\">In summary, transplantation is used as a <strong data-start=\"995\" data-end=\"1020\">consolidation therapy<\/strong> in selected high-risk patients, offering the best chance of achieving <strong data-start=\"1091\" data-end=\"1134\">stable remission and long-term survival<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Reassessment of Therapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"32\" data-end=\"307\">After completing treatment cycles, it is essential to evaluate the leukemia\u2019s response to therapy. This is performed through <strong data-start=\"157\" data-end=\"183\">bone marrow aspiration<\/strong>, which determines whether the disease is in <strong data-start=\"228\" data-end=\"269\">complete remission, partial remission<\/strong>, or still present (<strong data-start=\"289\" data-end=\"305\">non-response<\/strong>).<\/p>\n<p data-start=\"309\" data-end=\"549\">During this assessment, it is also possible to detect early signs of relapse by monitoring <strong data-start=\"400\" data-end=\"434\">minimal residual disease (MRD)<\/strong>, a highly sensitive method that identifies residual leukemia cells before the disease becomes clinically apparent.<\/p>\n<p data-start=\"551\" data-end=\"760\" data-is-last-node=\"\" data-is-only-node=\"\">The results are reviewed by the <strong data-start=\"583\" data-end=\"609\">Interdisciplinary Team<\/strong>, which decides whether treatment can be considered complete or whether it should be modified or continued, ensuring the best possible disease control.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"ongoing-support\" class=\"h2_anchor\"><\/span>Ongoing Support<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At <strong>INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong>, we provide continuous support before, during, and after treatment, accompanying each patient throughout the entire course of care and recovery.<\/p>\n\n\n\t<div id=\"block_6a3a5a35026bc\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Management of Side Effects<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"35\" data-end=\"319\">All cancer treatments are associated with <strong data-start=\"77\" data-end=\"93\">side effects<\/strong> that can affect the patient\u2019s <strong data-start=\"124\" data-end=\"143\">quality of life<\/strong> to varying degrees. Treatments for acute leukemia may also cause significant <strong data-start=\"221\" data-end=\"259\">physical and psychological effects<\/strong>, which can impact daily functioning and overall well-being.<\/p>\n<p data-start=\"321\" data-end=\"676\" data-is-last-node=\"\" data-is-only-node=\"\">At <strong>INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong>, attention to the patient\u2019s <strong data-start=\"386\" data-end=\"405\">quality of life<\/strong> remains a priority throughout the entire treatment pathway. The physicians and nurses of the <strong data-start=\"499\" data-end=\"525\">Multidisciplinary Team<\/strong> provide ongoing support to help manage side effects, including <strong data-start=\"589\" data-end=\"615\">nutritional counseling<\/strong>, <strong data-start=\"617\" data-end=\"642\">psychological support<\/strong>, and <strong data-start=\"648\" data-end=\"675\">pain management therapy<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Psychological Support<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"30\" data-end=\"249\">The impact of cancer also extends to the <strong data-start=\"71\" data-end=\"95\">psychological sphere<\/strong>. A cancer diagnosis is often a <strong data-start=\"127\" data-end=\"146\">traumatic event<\/strong> that affects all aspects of a person\u2019s life and may generate <strong data-start=\"208\" data-end=\"248\">anxiety, fear, anger, and depression<\/strong>.<\/p>\n<p data-start=\"251\" data-end=\"527\">At <strong>INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong>, alongside advanced medical therapies, the care pathway always includes <strong data-start=\"360\" data-end=\"402\">specialized psycho-oncological support<\/strong>, helping patients cope not only with treatment but also with the delicate phases of <strong data-start=\"487\" data-end=\"526\">physical and psychological recovery<\/strong>.<\/p>\n<p data-start=\"529\" data-end=\"690\" data-is-last-node=\"\" data-is-only-node=\"\">Patients may also participate in <strong data-start=\"562\" data-end=\"594\">psychological support groups<\/strong>, where they can share experiences with others who are facing or have faced a similar condition.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Direct Access to Specialists<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">To ensure timely support and provide prompt answers to questions or concerns, the\u00a0<strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>\u00a0offers a dedicated assistance service for all patients.<\/p>\n<p class=\"isSelectedEnd\">From\u00a0<strong>Monday through Friday<\/strong>, between\u00a0<strong>8:00 a.m. and 5:00 p.m.<\/strong>, patients can contact the\u00a0<a href=\"https:\/\/inoc.it\/en\/medical-area\/oncology-day-hospital\/\">Oncology Day Hospital<\/a>\u00a0Secretariat at\u00a0<strong>+39 011 993 3775<\/strong>\u00a0to request an urgent consultation.<\/p>\n<p>Patients are promptly connected with their specialist physician, ensuring rapid access to expert advice, clear information, and immediate support when needed.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Supportive and Palliative Care<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Cancer patients often have\u00a0<strong>complex needs<\/strong>\u00a0that extend beyond the treatment of the disease itself and require comprehensive,<strong>\u00a0multidisciplinary care.<\/strong><\/p>\n<p class=\"isSelectedEnd\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, patients who need additional support have access to specialists from a range of disciplines, ensuring personalized management of cancer-related symptoms and associated conditions. Services may include nutritional counseling, physical rehabilitation, pain management, and support for other medical needs that may arise during the course of treatment and recovery.<\/p>\n<p>The goal is to\u00a0<strong>improve quality of life, promote overall well-being, and provide comprehensive care<\/strong>\u00a0tailored to each patient\u2019s individual needs.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Social Work Services<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"26\" data-end=\"278\">The Social Work Service at INOC &#8211; Istituto Nazionale Oncologico Candiolo provides <strong>information, guidance, and support to patients and their families<\/strong> regarding access to community services and the welfare and social security benefits available under current legislation.<\/p>\n<p data-start=\"280\" data-end=\"491\">During dedicated consultations, social workers assist with matters such as disability recognition, access to aids and prosthetic devices, employment-related benefits and leave, and other social support services.<\/p>\n<p data-start=\"493\" data-end=\"621\" data-is-last-node=\"\" data-is-only-node=\"\">The service is available on\u00a0<strong data-start=\"521\" data-end=\"575\">Wednesdays and Fridays from 9:00 a.m. to 1:00 p.m.<\/strong>\u00a0and can be contacted at\u00a0<strong data-start=\"600\" data-end=\"620\">+39 011 993 3059<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Follow-up<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"18\" data-end=\"309\">After completion of treatment, a <strong data-start=\"51\" data-end=\"71\">follow-up period<\/strong> begins. During this phase, a series of <strong data-start=\"111\" data-end=\"155\">clinical examinations and medical visits<\/strong> are performed to monitor the <strong data-start=\"185\" data-end=\"213\">effectiveness of therapy<\/strong>, assess <strong data-start=\"222\" data-end=\"256\">treatment-related side effects<\/strong>, and evaluate the patient\u2019s <strong data-start=\"285\" data-end=\"308\">functional recovery<\/strong>.<\/p>\n<p data-start=\"311\" data-end=\"561\">Follow-up visits are particularly important for the <strong data-start=\"363\" data-end=\"393\">early detection of relapse<\/strong>, allowing timely intervention with appropriate treatment. They also provide an important opportunity for <strong data-start=\"499\" data-end=\"560\">discussion between the patient and the medical specialist<\/strong>.<\/p>\n<p data-start=\"563\" data-end=\"746\">The follow-up schedule is tailored according to the <strong data-start=\"615\" data-end=\"641\">type of acute leukemia<\/strong>, the <strong data-start=\"647\" data-end=\"670\">treatments received<\/strong>, the <strong data-start=\"676\" data-end=\"699\">response to therapy<\/strong>, and the patient\u2019s individual characteristics.<\/p>\n<p data-start=\"748\" data-end=\"983\">For patients who have undergone <strong data-start=\"780\" data-end=\"809\">stem cell transplantation<\/strong>, follow-up is initially very close, often requiring <strong data-start=\"862\" data-end=\"911\">weekly or more frequent outpatient monitoring<\/strong>, depending on the treatment protocol and the presence of complications.<\/p>\n<p data-start=\"985\" data-end=\"1063\" data-is-last-node=\"\" data-is-only-node=\"\">In general, follow-up visits become <strong data-start=\"1021\" data-end=\"1052\">progressively less frequent<\/strong> over time.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"multi-disciplinary-team\" class=\"h2_anchor\"><\/span>Multi Disciplinary Team<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every cancer requires a&nbsp;<strong>multidisciplinary approach<\/strong>&nbsp;at all stages of disease management. At INOC &#8211; Istituto Nazionale Oncologico Candiolo, this is provided by a team of specialists from various clinical and surgical departments, known as the&nbsp;<strong>GIC<\/strong>, Interdisciplinary Care Group (or MDT). The GIC ensures that each patient is supported throughout the diagnostic and therapeutic process, including arranging and coordinating examinations and maintaining communication with the patient and their family.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For each patient, the GIC (MDT) defines and shares a personalized care pathway based not only on the type and stage of the tumor but also on the patient\u2019s individual characteristics. The goal is to achieve the best possible outcomes both oncologically and functionally, while maintaining a high quality of life.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-divisions\" class=\"h2_anchor\"><\/span>Clinical Divisions<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>diagnostic and therapeutic pathway for leukemias<\/strong> at <strong>INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong> involves several <strong>clinical divisions<\/strong>, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/medical-oncology\/\" type=\"medical-area\" id=\"5169\">Medical Oncology<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/hemopoietic-stem-cell-transplantation-and-cellular-therapies-center\/\" type=\"medical-area\" id=\"5191\">Hemopoietic Stem Cell Transplantation and Cellular Therapies Center<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/oncology-day-hospital\/\" type=\"medical-area\" id=\"5183\">Day Hospital<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/radiotherapy\/\" type=\"medical-area\" id=\"5104\">Radiotherapy<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/laboratory-analysis\/\" type=\"medical-area\" id=\"5113\">Laboratory Analysis<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/pathologic-anatomy\/\" type=\"medical-area\" id=\"5118\">Anatomical Pathology<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-studies\" class=\"h2_anchor\"><\/span>Clinical Studies<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Researchers at <strong>INOC \u2013 Istituto Nazionale Oncologico Candiolo <\/strong>are actively involved in national and international projects on <strong>acute leukemia<\/strong>, with the aim of providing patients with the most advanced diagnostic and therapeutic options. The Institute is part of the national <strong>GIMEMA network<\/strong>, participating in experimental clinical trials and adhering to the most up-to-date clinical guidelines.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Through these collaborations, patients may gain access to <strong>next-generation drugs not yet widely available<\/strong>, including new monoclonal antibodies and targeted molecules designed to act on specific molecular or antigenic targets. Examples already used in clinical practice include <strong>FLT3 inhibitors, BCL-2 inhibitors, and tyrosine kinase inhibitors<\/strong>, administered alone or in combination with chemotherapy to improve treatment efficacy and prognosis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The main objective of the Institute is to collaborate with a broad network of researchers, collect robust clinical data, and objectively evaluate therapeutic strategies, thereby promoting continuous innovation in the treatment of <strong>acute leukemia<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"why-choose-us\" class=\"h2_anchor\"><\/span>Why Choose Us<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, acute leukemia patients are treated in a <strong>highly specialized<\/strong> manner, thanks to the synergistic work of the dedicated<a href=\"https:\/\/inoc.it\/en\/pathology\/acute-leukemias\/#multi-disciplinary-team\">&nbsp;Interdisciplinary Care Group (GIC)&nbsp;.<\/a><\/p>\n\n\n\t<div id=\"block_6a3a5a3502732\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Experience and Tailored Approach<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Thanks to the large number of cases treated each year, INOC &#8211; Istituto Nazionale Oncologico Candiolo is a\u00a0<strong>national reference<\/strong>\u00a0center for the care of this disease. This extensive experience allows us to manage even the most complex cases, always using a\u00a0<strong>personalized approach<\/strong>, tailored to the clinical and individual profile of each patient.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Imaging Technologies and Advanced Diagnostics<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Establishing a treatment plan always begins with an accurate and timely diagnosis. Patients have access to\u00a0<strong>state-of-the-art imaging technologies<\/strong>, such as ultrasound, contrast-enhanced CT, MRI, and cholangio-RM, which are critical for accurately assessing the extent of the tumor.<\/p>\n<p><strong>Advanced laboratory tests<\/strong>, including molecular analyses, are also available to help define biological features of the disease and guide treatment choices.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Minimally Invasive Surgical Techniques and Multidisciplinarity<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>When appropriate, surgeries are performed using\u00a0<strong data-start=\"244\" data-end=\"268\">minimally invasive<\/strong>, laparoscopic or robotic\u00a0<strong data-start=\"244\" data-end=\"268\">techniques<\/strong>. These approaches involve the use of camera-equipped instruments introduced into the abdomen through small incisions, thus reducing surgical trauma.\u00a0<strong>Benefits<\/strong>\u00a0to the patient include\u00a0<strong>shorter hospital stay times, faster recovery, and lower risk of complications compared with traditional open surgery.<\/strong><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Research and Access to Trials<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><!-- \/wp:heading --><\/p>\n<p>As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), INOC &#8211; Istituto Nazionale Oncologico Candiolo combines clinical care with a strong focus on scientific research. Patients can be considered for <a href=\"https:\/\/inoc.it\/en\/pathology\/acute-leukemias\/#clinical-studies\"><strong>participation in active clinical trials<\/strong><\/a>, offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Care and Support Every Step of the Way<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><a href=\"https:\/\/inoc.it\/en\/pathology\/acute-leukemias\/#multi-disciplinary-team\">The Interdisciplinary Care Group\u00a0<\/a>(GIC or MDT)\u00a0<strong>supports th<\/strong><strong>e patient at every stage<\/strong>: from diagnosis, through treatment, to follow-up. Special attention is paid to<strong>\u00a0nutritional support, psychological health and reintegration into daily life.<\/strong>\u00a0The organization of checkups, examinations, and treatment is designed to ensure\u00a0<strong>continuity, serenity, and a humane, caring<\/strong>\u00a0approach to each patient\u2019s needs.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-5235","pathology","type-pathology","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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