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Acute Myeloid Leukemia (AML) (Acute Promyelocytic Leukemia (APL) (t(15;17)…
Acute Myeloid Leukemia (AML)
Specs
>20% immature myeloid blasts
in BM
MPO+
(indicative of immature cells)
Crystal aggregates of MPO =
Auer Rods
Older adults
(avg age 50-60)
Acute Promyelocytic Leukemia (APL)
t(15;17)
Translocation of
retinoic acid receptor (RAR)
RAR disruption blocks maturation --> promyelocytes (blasts) accumulate
Abnl promyelocytes -- granules --
↑ DIC risk
Tx:
all-trans-retinoic acid
(
ATRA
- Vit A derivative)
ATRA
binds altered receptor --> blasts mature --> die!
Acute Monocytic Leukemia
Monoblast proliferation
Lack MPO
Blasts
infiltrate gums
Acute Megakaryoblastic Leukemia
Assoc w/
Down's (<5 yo)
Megakaryoblast proliferation
Lack MPO
Myelodysplastic Syndromes (MDS)
Prior exposure
to alkylating agents or radiotherapy
Can
become AML
Presentation
Cytopenias
Hypercellular
marrow
Abnormal cell maturation
Increased blasts (
6-19%
)
Mortality
due to
infection/bleeding
Think
INEFFECTIVE HEMATOPOIESIS
(low counts despite full marrow)
Treatment