Acute myeloid leukemia overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Acute myeloid leukemia (AML), also known as acute myelogenous leukemia, is a cancer of the myeloid line of white blood cells, characterized by the rapid proliferation of abnormal cells which accumulate in the bone marrow and interfere with the production of normal blood cells. Acute myeloid leukemia may be classified according to the French-American-British (FAB) classification and World Health Organization (WHO). This leukemia arises from myeloblasts, which are hematologic white cells that are normally involved in hematopoiesis. Genetic translocations involved in the pathogenesis of acute myeloid leukemia include translocations between chromosome 8 and 21 t(8;21) and translocations between chromosome 15 and 17 t(15;17). Acute myeloid leukemia must be differentiated from other diseases such as acute lymphoblastic leukemia, chronic myeloid leukemia, agranulocytosis, aplastic anemia and lymphoma. In 2015, the incidence of acute myeloid leukemia was approximately 6.5 per 100,000 individuals with a case-fatality rate of approximately 50% in the United States. The incidence of acute myeloid leukemia increases with age. Common risk factors in the development of acute myeloid leukemia are myelodysplastic syndromes, aplastic anemia, myelofibrosis and paroxysmal nocturnal hemoglobinuria. Common complications include infections, disseminated intravascular coagulation, pyoderma gangrenosum and hemorrhage. Symptoms of acute myeloid leukemia include fever, fatigue, weight loss and loss of appetite. Physical examination findings of acute myeloid leukemia include anemia, fever, pallor, Leukemia cutis, bruising, petechiae, ecchymosis and tachycardia. Laboratory findings consistent with the diagnosis of acute myeloid leukemia include leukocytosis, thrombocytopenia, anemia and leucopenia. If a lung infection is suspected chest x-ray may be helpful in the diagnosis. The mainstay therapy is chemotherapy and usually includes a combination of daunorubicin, cytarabine and etoposide or mitoxantrone and anabolic steroids. Supportive care includes intravenous nutrition, antimicrobial therapy, and replacement of blood products.
Historical Perspective
Leukemia was first described in 1827 by a french physician named Alfred-Armand-Louis-Marie Velpeau. In 1900 the myeloblast was first identified in the pathogenesis of acute myeloid leukemia.
Classification
Acute myeloid leukemia may be classified according to the French-American-British (FAB) classification and World Health Organization (WHO).
Pathophysiology
Acute myeloid leukemia arises from myeloblasts, which are hematologic white cells that are normally involved in hematopoiesis. Genetic translocations involved in the pathogenesis of acute myeloid leukemia include translocations between chromosome 8 and 21 t(8;21) and translocations between chromosome 15 and 17 t(15;17). Inversions in the chromosomal translocations in chromosome 16 inv(16) are involved in the pathogenesis of acute myeloid leukemia.
Differentiating Acute lymphoblastic leukemia from other Diseases
Acute myeloid leukemia must be differentiated from other diseases such as acute lymphoblastic leukemia, chronic myeloid leukemia, agranulocytosis, aplastic anemia and lymphoma.
Epidemiology and Demographics
In 2015, the incidence of acute myeloid leukemia was approximately 6.5 per 100,000 individuals with a case-fatality rate of approximately 50% in the United States. The incidence of acute myeloid leukemia increases with age; the median age at diagnosis is 63 years. Males are more commonly affected with acute myeloid leukemia than women. The male to female ratio is approximately 1.3 to 1.
Risk Factors
Common risk factors in the development of acute myeloid leukemia are myelodysplastic or myeloproliferative syndromes, aplastic anemia, myelofibrosis, paroxysmal nocturnal hemoglobinuria, polycythemia vera, chemical exposure and several congenital conditions such as Down syndrome, Bloom syndrome, Fanconi anemia, neurofibromatosis and congenital neutropenia.
Natural History, Complications, and Prognosis
Common complications of acute myeloid leukemia include infections, disseminated intravascular coagulation, pyoderma gangrenosum, hemorrhage and complications due to side effects of chemotherapy. Prognosis of acute myelogenous leukemia depends on cytogenetics. Cytogenetics that indicate a good prognosis include inversions in chromosome 16 inv(16), translocations between chromosome 8 and 21 t(8;21) and translocations between chromosome 15 and 17 t(15;17).
Diagnosis
History and Symptoms
Symptoms of acute myeloid leukemia include fever, fatigue, weight loss and loss of appetite.
Physical Examination
Common physical examination findings of acute myeloid leukemia include anemia, fever, pallor, Leukemia cutis, bruising, petechiae, ecchymosis and tachycardia.
Laboratory Findings
Laboratory findings consistent with the diagnosis of acute myeloid leukemia include leukocytosis, thrombocytopenia, anemia and leucopenia.
Chest X Ray
If a lung infection is suspected chest x-ray may be helpful in the diagnosis of acute myeloid leukemia.
CT
CT scan may be helpful in the diagnosis of acute myeloid leukemia.
Other Diagnostic Studies
Other diagnostic studies for acute myeloid leukemia include cytochemistry, flow cytometry, immunohistochemistry, PCR and biopsy.
Medical Therapy
The mainstay therapy from acute myeloid leukemia is chemotherapy and usually includes a combination of daunorubicin, cytarabine and etoposide or mitoxantrone and anabolic steroids. Supportive care includes intravenous nutrition, antimicrobial therapy, and replacement of blood products.
References