Rational pharmacotheray in acute and chronic leukemia

Leukemia, encompassing acute and chronic forms, is a heterogeneous group of hematological malignancies characterized by uncontrolled proliferation of immature or mature leukocytes. Rational pharmacotherapy aims to optimize treatment outcomes through evidence-based drug selection, tailored regimens, and minimization of toxicity. In acute leukemias (acute lymphoblastic leukemia [ALL] and acute myeloid leukemia [AML]), pharmacotherapy focuses on intensive multi-agent chemotherapy for induction of remission, followed by consolidation and maintenance phases. Agents such as anthracyclines, cytarabine, methotrexate, and vincristine are widely employed, with newer targeted therapies like tyrosine kinase inhibitors (TKIs) and monoclonal antibodies enhancing remission rates, particularly in Philadelphia chromosome-positive ALL and FLT3-mutated AML. In chronic leukemias (chronic myeloid leukemia [CML] and chronic lymphocytic leukemia [CLL]), long-term disease control rather than immediate cure is the primary goal. TKIs (imatinib, dasatinib, nilotinib) revolutionized CML management, transforming it into a chronic controllable disease. In CLL, agents such as Bruton’s tyrosine kinase inhibitors (ibrutinib), BCL-2 inhibitors (venetoclax), and anti-CD20 monoclonal antibodies (rituximab, obinutuzumab) provide superior efficacy compared with traditional chemotherapy. Supportive pharmacotherapy—including antimicrobials, hematopoietic growth factors, and transfusion support—plays a critical role in reducing complications and improving quality of life. Emerging precision medicine approaches, such as CAR-T cell therapy and molecularly guided regimens, further expand therapeutic possibilities. Rational pharmacotherapy in leukemia thus integrates conventional cytotoxic agents, targeted therapies, and supportive care, with individualized treatment plans based on leukemia subtype, genetic profile, disease stage, and patient-specific factors, to maximize survival and minimize adverse outcomes.