Acute myeloid leukemia
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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
History
Signs and symptoms
Causes
Epidemiology
Pathophysiology
Diagnosis
The first clue to a diagnosis of AML is typically an abnormal result on a complete blood count. While an excess of abnormal white blood cells (leukocytosis) is a common finding, and leukemic blasts are sometimes seen, AML can also present with isolated decreases in platelets, red blood cells, or even with a low white blood cell count (leukopenia).[1] While a presumptive diagnosis of AML can be made via examination of the peripheral blood smear when there are circulating leukemic blasts, a definitive diagnosis usually requires an adequate bone marrow aspiration and biopsy
A bone marrow examination is often performed to identify the type of abnormal blood cells; however, if there are many leukemic cells circulating in the peripheral blood, a bone marrow biopsy may not be necessary. Marrow or blood is examined via light microscopy as well as flow cytometry to diagnose the presence of leukemia, to differentiate AML from other types of leukemia (e.g. acute lymphoblastic leukemia), and to classify the subtype of disease (see below). A sample of marrow or blood is typically also tested for chromosomal translocations by routine cytogenetics or fluorescent in situ hybridization.
The diagnosis and classification of AML can be challenging, and should be performed by a qualified hematopathologist or hematologist. In straightforward cases, the presence of certain morphologic features (such as Auer rods) or specific flow cytometry results can distinguish AML from other leukemias; however, in the absence of such features, diagnosis may be more difficult.[2]
According to the widely used WHO criteria, the diagnosis of AML is established by demonstrating involvement of more than 20% of the blood and/or bone marrow by leukemic myeloblasts.[3] AML must be carefully differentiated from "pre-leukemic" conditions such as myelodysplastic or myeloproliferative syndromes, which are treated differently.
Because acute promyelocytic leukemia (APL) has the highest curability and requires a unique form of treatment, it is important to quickly establish or exclude the diagnosis of this subtype of leukemia. Fluorescent in situ hybridization performed on blood or bone marrow is often used for this purpose, as it readily identifies the chromosomal translocation (t[15;17]) that characterizes APL.[4]
Pathology
![AML - Auer Rods, DIC[5]](/index.php/File:AML.jpg)
![AML (with Auer Rods)[6]](/index.php/File:AML_(with_Auer_Rods).jpg)
(Images shown below are courtesy of Melih Aktan MD., Istanbul Medical Faculty - Turkey, and Kyoto University - Japan)
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AML-M0 -
AML-M1
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AML-M1 peroxidase -
AML-M1
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AML-M1 -
AML-M1
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AML-M2 -
AML-M2
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AML-M2 -
AML-M2
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AML-M3 -
AML-M3
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AML-M3 -
AML-M3
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AML-M3 Auer bodies -
AML-M3 Auer bodies
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AML-M3 variation -
AML-M4
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AML-M5a -
AML-M5a
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AML-M5a (alpha naphtyle acetat) -
AML-M5b
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AML-M5b -
AML-M7 -
AML-M7
Classification
Prognosis
Treatment
See also
Further reading
- Martin Abeloff (2004). Clinical Oncology (3rd. edition ed.). St. Louis, Mo.: Elsevier Churchill Livingstone. ISBN 0-443-06629-9. Unknown parameter
|coauthors=ignored (help) - Ronald Hoffman (2005). Hematology: Basic Principles and Practice (4th. edition ed.). St. Louis, Mo.: Elsevier Churchill Livingstone. ISBN 0-443-06629-9. Unknown parameter
|coauthors=ignored (help)
References
- ↑ Abeloff, Martin et al. (2004), p. 2834.
- ↑ Abeloff, Martin et al. (2004), p. 2835.
- ↑ Harris N, Jaffe E, Diebold J, Flandrin G, Muller-Hermelink H, Vardiman J, Lister T, Bloomfield C (1999). "The World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. Report of the Clinical Advisory Committee meeting, Airlie House, Virginia, November, 1997". Ann Oncol. 10 (12): 1419–32. PMID 10643532.
- ↑ Grimwade D, Howe K, Langabeer S, Davies L, Oliver F, Walker H, Swirsky D, Wheatley K, Goldstone A, Burnett A, Solomon E (1996). "Establishing the presence of the t(15;17) in suspected acute promyelocytic leukaemia: cytogenetic, molecular and PML immunofluorescence assessment of patients entered into the M.R.C. ATRA trial. M.R.C. Adult Leukaemia Working Party". Br J Haematol. 94 (3): 557–73. PMID 8790159.
- ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages
- ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages
External links
- Atlas of Hematology
- American Cancer Society page on Acute Myeloid Leukemia
- Association of Cancer Online Resource (ACOR) Leukemia Links
- Leukemia & Lymphoma Society page on Acute Myeloid Leukemia
- Childhood Acute Myeloid Leukemia
- National Marrow Donor Program
- Blood & Marrow Transplant Information Network
- National Cancer Institute (NCI) PDQ statement on AML for health professionals
ar:ابيضاض الدم النقوي الحاد de:Akute myeloische Leukämie he:לוקמיה מיאלואידית חריפה sr:Акутна мијелоцитна леукемија sv:Akut myeloisk leukemi