Cytogenetic study reveals non random chromosomal abnormalities in 50-80% of patients with acute leukemia. These changes are correlated with morphological [t(15;17) closely connected with FAB M3] and (or) immunological findings [t(1;19) with pre-B/early pre-B ALL]. Karyotype in ALL is an independent prognostic factor. Patients with ALL and hyperdiploidy > 50 chromosomes fared the best as well as patients with AML and inv(16). Conversely the Philadelphia chromosome or t(4;11) in ALL, del5q or trisomy 8 in AML have shown an adverse predictive value. Cytogenetic study is a useful tool to detect relapse and residual disease. Cytogenetic abnormalities have also provided focus for molecular studies of leukemogenesis.