ABSTRACT
Acute leukemia has been recognized as a complex and rapidly fatal disease since its first description approximately 150 years ago.1-3 The history of effective treatment for acute leukemia began with the introduction of aminopterin in 1948.4 The natural history of untreated acute leukemia is tragically short, regardless of the type of leukemia. From onset of symptoms to death and from diagnosis to death, the median survivals for children with acute lymphoblastic leukemia (ALL) are 3.6 months (95% confidence interval, CI, 3.2-4.0) and 3.5 months (95% CI 2.3-5.4), respectively; for children with acute myeloid leukemia (AML), they are 3.4 months (95% CI 1.6-5.5) and 1.2 months (95% CI 0.6-2.4); for adults with ALL, they are 3.8 months (95% CI 2.6-5.7) and 1.4 months (95% CI 0.7-2.9); and for adults with AML, they are 4.2 months (95% CI 2.6-7.1) and 2.0 months (95% CI 1.4-2.9).5 The natural history of untreated disease is one of progressive deterioration, with death attributed to the consequences of bone marrow failure, including hemorrhage due to thrombocytopenia and leukostasis-related hemorrhagic infarction and overwhelming infection secondary to progressive neutropenia and to organ failure.
