Summary
Definition
History and exam
Key diagnostic factors
- pallor
- ecchymoses or petechiae
Other diagnostic factors
- fatigue
- dizziness
- palpitations
- dyspnea
- fever and infections
- lymphadenopathy
- hepatosplenomegaly
- mucosal bleeding
- skin and/or testicular mass
- skin infiltration
- gingival enlargement
- bone pain
- skin chloromas
- abdominal pain
- neurologic symptoms (e.g., headache, confusion)
Risk factors
- age over 65 years
- previous treatment with chemotherapy
- previous hematologic disorders
- inherited genetic conditions
- constitutional chromosomal abnormalities
- radiation exposure
- benzene exposure
- environmental exposures
- male sex
Diagnostic tests
1st tests to order
- CBC with differential
- peripheral blood smear
- coagulation panel
- serum electrolytes
- serum uric acid
- serum lactate dehydrogenase (LDH)
- renal function
- liver function tests
- bone marrow evaluation
- genetic testing
Tests to consider
- CNS imaging and lumbar puncture
- FDG-PET/CT scan
- human leukocyte antigen (HLA) typing
- chest x-ray
- echocardiogram
- multigated acquisition scan
Treatment algorithm
newly diagnosed AML: suitable for intensive chemotherapy
newly diagnosed AML: not suitable for intensive chemotherapy
newly diagnosed non-high-risk acute promyelocytic leukemia (APL)
newly diagnosed high-risk acute promyelocytic leukemia (APL)
complete remission: AML
complete remission: acute promyelocytic leukemia (APL)
relapsed or refractory AML
relapsed or refractory acute promyelocytic leukemia (APL)
Contributors
Authors
Vijaya Raj Bhatt, MBBS, MS
Associate Professor
Section Leader, Malignant Hematology
University of Nebraska Medical Center Division of Hematology-Oncology
Nebraska
NE
Disclosures
VRB has participated in a Safety Monitoring Committee for Protagonist Therapeutics. He has received consulting fees from Imugene; research funding (institutional) from Abbvie, Pfizer, Incyte, Jazz, and NMDP; and drug support (institutional) from Chimerix for a trial.
Prajwal Dhakal, MBBS
Clinical Assistant Professor of Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation
University of Iowa
Iowa City
IA
Disclosures
PD declares that he has no competing interests.
Acknowledgements
Dr Vijaya Raj Bhatt and Dr Prajwal Dhakal would like to gratefully acknowledge Dr Kavita Raj and Dr Priyanka Mehta, previous contributors to this topic.
Disclosures
KR declares that she has no competing interests. PM is an author of a reference cited in this topic.
Peer reviewers
Naveen Premnath, MD
Assistant Professor of Medicine
Division of Hematology, Oncology, and Transplantation
University of Minnesota
Minnesota
MN
Disclosures
NP declares that he has no competing interests.
Rebecca Connor, MD
Chief Fellow
Section of Hematology and Oncology
Department of Internal Medicine
Wake Forest University Baptist Medical Center
Winston-Salem
NC
Disclosures
RC declares that she has no competing interests.
Roger M. Lyons, MD, FACP
Clinical Professor of Medicine
University of Texas Health Science Center
San Antonio
Cancer Care Network of South Texas
San Antonio
TX
Disclosures
RML declares that he has no competing interests.
Shankaranarayana Paneesha, MD, MRCP, FRCPath
Consultant Haematologist
Department of Haematology and Stem Cell Transplantation
Heartlands Hospital
Birmingham
UK
Disclosures
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
UK
Disclosures
DM declares that he has no competing interests.
Differentials
- Acute lymphoblastic leukemia (ALL)
- Biphenotypic leukemia
- Myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase fusion genes (MLNE)
More DifferentialsGuidelines
- NCCN guidelines: acute myeloid leukemia
- Recommendations for laboratory testing of UK patients with acute myeloid leukaemia
More Guidelines- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer