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Acute myeloid leukaemia (AML) (Clinical presentation (Malaise, fatigue,…
Acute myeloid
leukaemia (AML)
Epidemiology
Commonest acute leukaemia in adults
Inc with age, mainly elderly
Pathophysiology
Defect
Neoplastic prliferation of blast cells of
the myeloid lineage
Often caused by Chr translocation e.g. RAR-PML
Mechanism
Immature precursor cells so proliferate rapidly and have minimal mature functions
Marrow failure due to proliferation of immature WBCs, also infiltration of malignant cells into organs and tissues
Risk
factors
Chemicals e.g. benzene
Radiation
Chemotherapy
MPS
Age
Down syndrome
Clinical
presentation
Malaise, fatigue
Infections
Bruising. bleeding
Gum hypertrophy
Night sweats
Fever
Weight loss
Bony pains
Diagnosis
Examination
ENT exam
Gum hypertrophy
Abdo exam
Hepatomegaly, splenomegaly, LNs
Investigations
Bloods
FBC (low Hb, low Plt, high WCC), U+E, LFT (often deranged),
clotting (may be deranged), blood cultures (?sepsis)
Blood film (may see oblasts, Auer rods if RAR-PML)
Imaging
CXR: mediastinal LNs
Abdo: abdominal LNs
Bedside
Obs (may have fever)
Height/weight (weight loss)
Biopsy
Biopsy/aspirate: blasts, AUR rods if RAR/PML;
immunophenotype and cytogenetics
History
DH
Meds, allergies
FH
Leukaemia, cancer syndromes
PMH
Known medical conditions,
previous chemotherapy/RT
SH
Living arrangements, occupation,
smoking, alcohol
PC/HPC
Malaise, fatigue, weight loss,
bruising/bleeding, bone pain,
fevers, infections
Management
Medical
Chemotherapy
Indication: induction, maintenance
E.g. danaurubicin plus AraC
SEs: pancytopenia
Surgical
BMT
Indication: young fit patients after remission
MOA: chemo or total body irradiation to destroy
leukaemic cells, then autograft/allograft transplant
SEs: GvHD, infections, relapse, infertility
Conservative
Information, advice, support
MDT (speciality medic and surgeon, speciality nurse,
psychologist, counselling)
Complications
CNS involvement
Infections
Abx, antifungal and antivirals
Neutropenic sepsis
DIC
Pancytopenia
VTEs
VTE prophylaxis
Tumour lysis syndrome
Prophylactic allopurinol pre-chemo
Definition
Malignancy of
leukocytes of the
myeloid lineage
Prognosis
Poor, untx death in 2m,
treated 3y survival 20%
