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Acute myeloid leukemia

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Acute myeloid leukemia . Malignant clonal disorder of immature hematopoietic cells characterized by ab b erant hematopoietic cellular proliferation and maturation. Leukamic blasts may express capabilities for maturation to a variable degree,

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slide1

Acute myeloid leukemia

  • Malignant clonal disorder of immature hematopoietic
  • cells characterized by abberant hematopoietic cellular
  • proliferation and maturation. Leukamic blasts may
  • express capabilities for maturation to a variable degree,
  • which lead to morphological heterogeneity
slide2

Acute leukemias

  • Adults:
  • acute lymphoblastic leukemia (ALL) 20%
  • acute myeloid leukemia (AML) 80%
slide3

Cytological criteria for the diagnosis

of acute myeloid leukaemia:

French-American-British (FAB) classification

slide4

Cytological criteria for the diagnosis

of acute myeloid leukaemia:

French-American-British (FAB) classification

slide5

Cytological criteria for the diagnosis

of acute myeloid leukaemia:

French-American-British (FAB) classification

slide6

Cytological criteria for the diagnosis

of acute myeloid leukaemia:

French-American-British (FAB) classification

slide7

Cytological criteria for the diagnosis

of acute myeloid leukaemia:

French-American-British (FAB) classification

acute myeloid leukemia clinical features
Acute myeloid leukemia Clinical features
  • Suddent onset of the disease and very fast progression
  • If not treated  death after a few months
  • Most of the common systemic manifestations, such a fatigue, weakness, fever and weight loss, are non-specific
acute myeloid leukemia clinical features9
Acute myeloid leukemia Clinical features
  • Infiltration of bone marrow by leukemic cells

supression of normal hematopoietic progenitor cells growth  granulocytopenia, thrombocytopenia and anemia

  • infection of skin, mucous membranes, gums, respiratory, GI and GU tracts
  • bleeding in skin, mucous membranes, gums, GI and GU tracts
  • fatigue, weakness
acute myeloid leukemia clinical features10
Acute myeloid leukemia Clinical features
  • The prevalence and degree of organ infiltration vary somewhat with the different types of leukemia
  • abdominal fullness (enlargement of the liver and spleen)
  • gum hypertrophy (AML-M4 and M5)
  • bone and join pain and tenderness
  • neurological symptoms: headache, nausea, vomiting, blurred vision, cranial nerve dysfunction (AML-M4 and M5)
  • DIC (AML-M3)
acute myeloid leukemia
Acute myeloid leukemia
  • The diagnosis of AML is primarily based on morphological (>30% of basts and suppression of other lineages) and cytochemical criteria
  • Immunophenotyping, cytogenetic analysis and molecular examination are employed to add specific information for a more precise diagnosis (e.g. to identify undifferentiated leukemias as being myeloid)
acute myeloid leukemia remission induction treatment
Acute myeloid leukemia Remission induction treatment
  • The mainstay drugs have been daunorubicin and cytosine arabinoside* given as a 3+7 day schedule
  • number of cycle 1-2

REMISSION 60-80%

*in the treatment of AML-M3 all-trans retinoic acid is also used

REMISSION 80%

acute myeloid leukemia the aims of the induction treatment
Acute myeloid leukemia The aims of the induction treatment
  • obtain the complete remission (RC)*

and restoration of polyclonal hemopoiesis

* defined as reduction of the blast cells in the marrow < 5% (inapparent) and normalzation of the picture of the peripheral blood

 However, monoclonal hemopoiesis is still present!

acute myeloid leukemia principle of the treatment
Acute myeloid leukemia Principle of the treatment
  • CNS prophylaxis/treatment
  • if clinical symptoms suggest meningeal leukemia

AML-M4 or 5

patients < 18 years old

 combination of drugs administered intrathecally

(Ara-C plus Fenicort, MTX plus Fenicort)

or

CNS radiotherapy

acute myeloid leukemia post remission chemotherapy
Acute myeloid leukemia Post-remission chemotherapy

The aims of the intensification treatment:

- elimination of residual disease

  • prolongation of the time of remission
acute myeloid leukemia risk groups
Acute myeloid leukemiarisk groups
  • Good risk disease
  • t(8;21), t(15;17) inv 16
  • Standard risk disease
  • Poor risk disease

-abnormalities of chromosome 5, complex changes, monosomy 7 and 3q-

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