Acute myeloid leukemia

Last reviewed: 26 Aug 2023
Last updated: 09 Jun 2023

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
  • skin chloromas
  • abdominal pain
Other diagnostic factors

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
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
  • bone marrow evaluation
  • cytogenetic and molecular investigations
More 1st investigations to order

Investigations to consider

  • lumbar puncture
  • human leukocyte antigen (HLA) typing
  • chest x-ray
  • echocardiogram
  • multigated acquisition scan
More investigations to consider

Treatment algorithm

ACUTE

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)

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 is an author of a reference cited in this topic.

Peer reviewers

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.

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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