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Acute myeloid leukemia

Last reviewed: 12 Oct 2024
Last updated: 05 Jul 2024

Summary

Definition

History and exam

Key diagnostic factors

  • pallor
  • ecchymoses or petechiae
Full details

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)
Full details

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
Full details

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
Full details

Tests to consider

  • CNS imaging and lumbar puncture
  • FDG-PET/CT scan
  • human leukocyte antigen (HLA) typing
  • chest x-ray
  • echocardiogram
  • multigated acquisition scan
Full details

Treatment algorithm

ACUTE

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)

ONGOING

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.

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