Acute myeloid leukemia

Acute myeloid leukemia (AML) is a life-threatening hematologic malignancy that predominantly occurs in older adults.

Many subtypes exist; acute promyelocytic leukemia (APML) may be associated with life-threatening coagulopathy.

Characteristically, abnormal blasts are present in the bone marrow (and in some cases the peripheral blood and extramedullary tissue) and normal hematopoiesis is reduced.

Workup includes bone marrow aspirate and trephine biopsy. Cytogenetic analysis and molecular genetic testing inform the prognosis, and potentially the preferred therapy.

Most patients are treated with chemotherapy induction and consolidation regimens. Hematopoietic stem cell transplantation may also be used in select patients.

Acute myeloid leukemia (AML) is a life-threatening hematologic malignancy caused by clonal expansion of myeloid blasts in the bone marrow, peripheral blood, or extramedullary tissues.

AML is a highly heterogeneous disease that can be classified into subtypes based on blast count (in the bone marrow or peripheral blood) and the presence of genetic abnormalities.[1]Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: myeloid and histiocytic/dendritic neoplasms. Leukemia. 2022 Jul;36(7):1703-19. https://www.doi.org/10.1038/s41375-022-01613-1 http://www.ncbi.nlm.nih.gov/pubmed/35732831?tool=bestpractice.com [2]Arber DA, Orazi A, Hasserjian RP, et al. International Consensus Classification of Myeloid Neoplasms and Acute Leukemias: integrating morphologic, clinical, and genomic data. Blood. 2022 Sep 15;140(11):1200-28. https://www.doi.org/10.1182/blood.2022015850 http://www.ncbi.nlm.nih.gov/pubmed/35767897?tool=bestpractice.com ​See Classification section. 

AML may arise de novo, or secondary to a prior treatment, preexisting hematologic disorder (e.g., myelodysplastic syndrome), or germline predisposition.[1]Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: myeloid and histiocytic/dendritic neoplasms. Leukemia. 2022 Jul;36(7):1703-19. https://www.doi.org/10.1038/s41375-022-01613-1 http://www.ncbi.nlm.nih.gov/pubmed/35732831?tool=bestpractice.com [2]Arber DA, Orazi A, Hasserjian RP, et al. International Consensus Classification of Myeloid Neoplasms and Acute Leukemias: integrating morphologic, clinical, and genomic data. Blood. 2022 Sep 15;140(11):1200-28. https://www.doi.org/10.1182/blood.2022015850 http://www.ncbi.nlm.nih.gov/pubmed/35767897?tool=bestpractice.com

The acute promyelocytic leukemia (APML) subtype of AML is characterized by a distinctive cytomorphology (hypergranular promyelocytes with bilobed nuclei and bundles of Auer rods), a tendency for coagulopathy (due to thrombocytopenia and disseminated intravascular coagulation), and a specific t(15;17)(q22;q12) balanced translocation resulting in the PML::RARA fusion gene. [Figure caption and citation for the preceding image starts]: Peripheral blood film of a patient with acute promyelocytic leukemia showing hypergranular promyelocytes with bilobed nuclei and bundles of Auer rodsFrom the collection of Drs K. Raj and P. Mehta; used with patient consent [Citation ends].[Figure caption and citation for the preceding image starts]: Peripheral blood film of a patient with acute promyelocytic leukemia showing hypergranular promyelocytes, some with bundles of Auer rodsFrom the collection of Drs K. Raj and P. Mehta; used with patient consent [Citation ends].