Acute myeloid leukemia

Last reviewed: 6 Nov 2022
Last updated: 04 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • pallor
  • ecchymoses or petechiae
More key diagnostic factors

Other diagnostic factors

  • fatigue
  • dizziness
  • palpitations
  • dyspnea
  • infections or fever
  • lymphadenopathy
  • hepatosplenomegaly
  • mucosal bleeding
  • skin or testicular mass
  • skin infiltration
  • gingival enlargement
  • bone pain
  • abdominal pain
Other diagnostic factors

Risk factors

  • age over 65 years
  • previous treatment with chemotherapy
  • previous hematologic disorders
  • inherited genetic conditions
  • constitutional karyotype abnormalities
  • radiation exposure
  • benzene exposure
  • environmental exposures
  • male sex
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC with differential
  • peripheral blood smear
  • coagulation panel
  • serum electrolytes and uric acid
  • renal function
  • LFTs
  • serum lactic dehydrogenase
More 1st investigations to order

Investigations to consider

  • bone marrow aspirate and trephine biopsy
  • immunophenotyping (flow cytometry)
  • cytogenetic and molecular investigations
  • lumbar puncture
  • HLA antigen typing
  • chest x-ray
  • echocardiogram
  • multigated acquisition scan
More investigations to consider

Treatment algorithm

ACUTE

newly diagnosed AML: suitable for standard chemotherapy

newly diagnosed AML: not suitable for standard chemotherapy

newly diagnosed non-high-risk acute promyelocytic leukemia (APML)

newly diagnosed high-risk acute promyelocytic leukemia (APML)

ONGOING

complete remission: AML

complete remission: non-high-risk acute promyelocytic leukemia (APML)

complete remission: high-risk acute promyelocytic leukemia (APML)

relapsed or refractory AML

relapsed or refractory acute promyelocytic leukemia (APML)

Contributors

Authors

Kavita Raj, MD, MRCP, FRCPath, PhD

Consultant Haematologist

Guy's and St Thomas' NHS Trust

London

UK

Disclosures

KR declares that she has no competing interests.

Priyanka Mehta, MD, FRCP, FRCPath

Consultant Haematologist

University Hospital Bristol

Bristol

UK

Disclosures

PM declares that she has no competing interests.

Peer reviewers

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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  • Guidelines

    • NCCN guidelines: acute myeloid leukemia
    • Clinical practice recommendation on hematopoietic stem cell transplantation for acute myeloid leukemia patients with FLT3-internal tandem duplication
    More Guidelines
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