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Acute Myelogenous Leukemia
- epidemiology
- signs and symptoms
- diagnosis
- subtypes
- mutations
- causes and risk factors
- treatments
- course
- patient education
- community resources
- references
AML is a disease of blocked differentiation and continuous proliferation of myeloid progenitor cells, which take over bone marrow and lead to acute disease.
Epidemiology
There is an incidence of 3/100,000 per year.
The median age of onset is 60.
Signs and Symptoms
AML has a short onset in weeks.
- fever and fatigue, mimicking the flu (anemia)
- bruising (thrombocytopenia)
- infection
- gingival hypertrophy
- skin infiltration (Sweet syndrome)
AML is caused by an arrested differentiation of myeloid blasts, leading to their accumulation in the bone marrow.
Diagnosis
Labs:
- high or low white count, with blasts
- blasts occupy at least 20% of bone marrow
Auer rods (coalescence of primary granules) are present in myeloid blasts but not lymphoid blasts
AML is at least 30% blast cells in peripheral blood cells
Subtypes
Over 8 types of myeloid leukemias
M3 - promyelocytic
- common-ish
APL
- better prognosis
- less intesive therapy
- differentiation therapy - All trans retinoic acid
- arsenic dioxide
Mutations
Transcription of differentiation is inhibited by AML/ETO fusion protein and recruitment of repressors
monosomy 7
RAEB
Causes and Risk Factors
Ionizng radiation
- chemotherapy
- benzene
previous chemotherapy
Down syndrome
Treatments
chemotherapy
- 5 intensive blocks over 6 months
supportive care
- more intense than ALL
- mandatory hospitalization over 6 months
- high risk of severe infection
- often trips to the ICU
Course
- overall survival ~65%
- toxic deaths more common than ALL
- relapse = poor prognosis
Patient Education
Community Resources