A life-threatening disorder that predominantly occurs in older adults.
Many subtypes exist, of which acute promyelocytic leukaemia merits specific management.
Characteristically, abnormal blasts are present in the peripheral blood and normal haematopoiesis is reduced. Definitive diagnosis requires bone marrow biopsy. Presence of blast cells in ≥20% of the bone marrow cells confirms the diagnosis.
Cytogenetic abnormalities are prognostically important and affect patient management.
Most patients are treated with chemotherapy induction, consolidation, and maintenance regimens. Haematopoietic stem cell transplantation may also be used in select patients.
It is important to rapidly identify acute promyelocytic leukaemia, as associated coagulopathy may be life threatening.
Although most patients achieve complete remission, a high incidence of relapse leads to poor overall survival.
Acute myeloid leukaemia (AML) is the clonal expansion of myeloid blasts in the bone marrow, peripheral blood, or extramedullary tissues. Bone marrow blasts of at least 20% are diagnostic. The presence of specific clonal cytogenetic abnormalities, such as t(8;21)(q22;q22), inv(16)(p13;q22), t(16;16)(p13;q22), and t(15;17)(q22;q12), also define AML irrespective of the blast count. AML may arise de novo or secondary to a pre-existing haematological disorder, such as myelodysplastic syndrome.
Acute promyelocytic leukaemia (APML) is a form of AML with distinct cytological and clinical features. The classic appearance of APML is a normal WBC count, bi-lobed nuclei, hypergranulated blasts, and bundles of Auer rods.
History and exam
Kavita Raj, MD, MRCP, FRCPath, PhD
Guy's and St Thomas' NHS Trust
KR declares that she has no competing interests.
Priyanka Mehta, MD, FRCP, FRCPath
University Hospital Bristol
PM declares that she has no competing interests.
Rebecca Connor, MD
Section of Hematology and Oncology
Department of Internal Medicine
Wake Forest University Baptist Medical Center
RC declares that she has no competing interests.
Roger M. Lyons, MD, FACP
Clinical Professor of Medicine
University of Texas Health Science Center
Cancer Care Network of South Texas
RML declares that he has no competing interests.
Shankaranarayanan Paneesha, MD, MRCP, FRCPath
Department of Haematology and Stem Cell Transplantation
SP declares that he has no competing interests.
David Marks, MD, MRCP, MRCPath
Professor of Haematology & Stem Cell Transplantation
Department of Molecular and Cellular Medicine
University of Bristol
DM declares that he has no competing interests.
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