Paediatric Acute Leukaemia: State-of-the-art Management in the Era of Precision Medicine and Immunotherapy

Background: Acute leukaemia is the most common childhood malignancy, comprising predominantly acute lymphoblastic leukaemia (ALL) and, less frequently, acute myeloid leukaemia (AML). Over the past several decades, advances in disease biology, molecular diagnostics, risk-adapted therapy and supportive care have substantially improved survival outcomes in children with acute leukaemia. Methods: A narrative review of the contemporary literature was undertaken to summarise recent developments in the epidemiology, molecular characterisation, risk stratification and management of paediatric acute leukaemia, with particular emphasis on measurable residual disease (MRD)-guided therapy, targeted therapeutics and immunotherapeutic approaches. Results: Genomic profiling and MRD assessment have transformed risk stratification and treatment individualisation in both ALL and AML. In ALL, incorporation of immunotherapeutic agents has significantly improved outcomes in relapsed and refractory disease. In