The small, non-coding RNAs known as piwi-interacting RNAs (piRNAs) serve essential roles in gene regulation by silencing transposable elements and protecting oncogenes and tumour suppressors. The production of piRNA bioactive forms uses precursor mRNAs, which team with Piwi proteins to support genome maintenance. Accurate leukaemia regulation requires piRNAs because abnormalities in these regulatory elements contribute to disease development and drug resistance progression. Their utility in disease detection appears promising through their distinct pattern expression across different leukaemia subtypes. These piRNA markers promise to enhance early detection of diseases and provide treatment effectiveness and outcome information. Lesions examined by microarrays qRT-PCR and high-throughput sequencing provide professionals with essential tools for studying piRNA profiles and tracking their activities in leukaemia treatment. PiRNAs establish interactions with microRNAs and long non-coding RNAs through complex regulatory networks, contributing to leukaemia development. The therapeutic applications of piRNAs in leukaemia treatment have proven promising, yet additional research is necessary to understand their specific functions and improve standardized detection capability. The field requires future investigations dedicated to designing piRNA-based diagnostic instruments, researching piRNA-derived drug resistance prevention strategies, and optimizing individualized treatment plans for leukaemia patients.
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