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ALL / Haematology
Acute myeloid leukaemia
Acute myeloid leukaemia
Acute myeloid leukaemia (AML) is the most common form of acute leukaemia in adults. It may arise de novo (primary disease) or as a secondary transformation of a myelodysplastic or myeloproliferative disorder.Features are largely related to bone marrow failure:
- anaemia: pallor, lethargy, weakness
- neutropenia: total white cell counts may be high, but functional neutrophils are low, leading to recurrent or severe infections
- thrombocytopenia: easy bruising, mucosal bleeding, petechiae
- splenomegaly
- bone pain
Poor prognostic features
- > 60 years
- failure to achieve remission (< 20% blasts) after first course of chemotherapy
- adverse cytogenetics: deletions of chromosome 5 or 7, complex karyotype, FLT3-ITD mutation
Acute promyelocytic leukaemia M3
- associated with t(15;17)
- fusion of PML and RAR-alpha genes
- typically presents at a younger age (average ~25–35 years)
- Auer rods (needle-shaped inclusions; highlighted with myeloperoxidase stain)
- DIC and severe thrombocytopenia are common presenting features
- good prognosis with all-trans retinoic acid (ATRA) and arsenic trioxide
Classification (World Health Organisation, 2022 update)
- AML with recurrent genetic abnormalities (e.g. t(8;21), inv(16), t(15;17))
- AML with myelodysplasia-related changes
- Therapy-related myeloid neoplasms
- AML, defined by mutated genes (e.g. NPM1, CEBPA, RUNX1, TP53, FLT3)
- Myeloid sarcoma
- Acute myeloid leukaemia, not otherwise specified (NOS)
- Blastic plasmacytoid dendritic cell neoplasm
+PassMedicine Notes
Acute myeloid leukaemia (AML) is the most common form of acute leukaemia in adults. It may arise de novo (primary disease) or as a secondary transformation of a myelodysplastic or myeloproliferative disorder.
Features are largely related to bone marrow failure:- anaemia: pallor, lethargy, weakness
- neutropenia: total white cell counts may be high, but functional neutrophils are low, leading to recurrent or severe infections
- thrombocytopenia: easy bruising, mucosal bleeding, petechiae
- splenomegaly
- bone pain
- > 60 years
- failure to achieve remission (< 20% blasts) after first course of chemotherapy
- adverse cytogenetics: deletions of chromosome 5 or 7, complex karyotype, FLT3-ITD mutation
- associated with t(15;17)
- fusion of PML and RAR-alpha genes
- typically presents at a younger age (average ~25–35 years)
- Auer rods (needle-shaped inclusions; highlighted with myeloperoxidase stain)
- DIC and severe thrombocytopenia are common presenting features
- good prognosis with all-trans retinoic acid (ATRA) and arsenic trioxide
- AML with recurrent genetic abnormalities (e.g. t(8;21), inv(16), t(15;17))
- AML with myelodysplasia-related changes
- Therapy-related myeloid neoplasms
- AML, defined by mutated genes (e.g. NPM1, CEBPA, RUNX1, TP53, FLT3)
- Myeloid sarcoma
- Acute myeloid leukaemia, not otherwise specified (NOS)
- Blastic plasmacytoid dendritic cell neoplasm
