ACUTE MYELOID LEUKEMIA

ALSO CALLED

• Acute myelocytic leukemia

• Acute myelogenous leukemia
• Acute granulocytic leukemia
• Acute non lymphocytic leukemia
 DEFINATION

• Uncontrolled proliferation of myeloblasts, precursors of granulocytes.

There is hyperplasia of bone marrow.
• Onset - abrupt and dramatic.
• Males > females .
 ETIOLOGY AND RISK FACTORS
• Smoking
• Chemicals – benzene , pesticides , ionizing radiation , some cleaning products ,
detergent , and paint strippers.
• Chemotherapy drugs – cyclophosphamide , doxorubicin , methotrexate ,
cisplatin , carboplatin , and all alkylating agents – myeloblastic syndrome – AML .
• Topoisomerase 2 inhibitors – without developing myeloblastic syndrome – AML
• Period between exposure and evidence of acute leukemia – 3-5 yrs for alkylating
agents or radiation exposure .
• But only 9-12 months for topoisomerase 2 inhibitors.
• Genetic – down syndrome and trisomy 8
• Exposure to increase doses of radiation.
• Certain blood conditions – myeloproliferative disorders – chronic myelogenous
leukemia.
 EPIDEMIOLOGY
• RECENT EPIDEMIOLOGICAL TRENDS IN US –
• New cases ( US 2009 ) – 12,810
• Deaths ( US 2009 ) -9000
• Median age at diagnosis - 67 yrs
• 5 yrs relative survival rates 1996 -2004 – 21.9%
• More common in whites .
 PATHOPHYSIOLOGY

• Maturational arrest of marrow cells in earlier stages of development

• Involves activation and inactivation of gene through chromosomal translocations

and other genetic and / or epigenetic abnormalities.

• decreased production of normal blood cells

• AML
 CLINICAL FEATURES

• Anaemia , neutropenia , thrombocytopenia ,organ infilteration with leukemic

cells.
• Organ infilteration occurs most commonly in monocytic subtypes .
• Patient complaints – fatigue , weakness , shortness of breath , weight loss , fever ,
bleeding , petechiae , early satiety , and fullness in right upper quadrant from
splenomegaly .
• Bone pain resulting from high leukemic cell burden and increased pressure in
marrow.
• Altered mental status.
 DIAGNOSTIC EVALUATION

• History and physical examination.

• Bone marrow aspiration usually from pelvic bone
• BM biopsy
• Spinal fluid – if S/S of brain involvement appear .
• Lab tests – CBC
• Microscopy – blast > 20%
• Imaging tests – X ray , CT , MRI , USG
• Genetic tests – cytogenetics , FISH ,PCR
SUBCLASSIFICATION