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. See Classification section.
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.
History and exam
Key diagnostic factors
- ecchymoses or petechiae
Other diagnostic factors
- infections or fever
- mucosal bleeding
- skin or testicular mass
- skin infiltration
- gingival enlargement
- bone pain
- skin chloromas
- abdominal pain
- 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
1st investigations to order
- CBC with differential
- peripheral blood smear
- coagulation panel
- serum electrolytes and uric acid
- renal function
- serum lactic dehydrogenase
- bone marrow evaluation
- cytogenetic and molecular investigations
Investigations to consider
- lumbar puncture
- human leukocyte antigen (HLA) typing
- chest x-ray
- multigated acquisition scan
newly diagnosed AML: suitable for standard dose-intense chemotherapy
newly diagnosed AML: not suitable for standard dose-intense chemotherapy
newly diagnosed non-high-risk acute promyelocytic leukemia (APML)
newly diagnosed high-risk acute promyelocytic leukemia (APML)
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)
- Acute lymphoblastic leukemia
- Biphenotypic leukemia
- Myelodysplastic syndrome
- NCCN guidelines: acute myeloid leukemia
- Recommendations for laboratory testing of UK patients with acute myeloid leukaemia
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