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Acute myeloid leukemia

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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Acute myeloid leukemia

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  1. 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

  2. Acute leukemias • Adults: • acute lymphoblastic leukemia (ALL) 20% • acute myeloid leukemia (AML) 80%

  3. Cytological criteria for the diagnosis of acute myeloid leukaemia: French-American-British (FAB) classification

  4. Cytological criteria for the diagnosis of acute myeloid leukaemia: French-American-British (FAB) classification

  5. Cytological criteria for the diagnosis of acute myeloid leukaemia: French-American-British (FAB) classification

  6. Cytological criteria for the diagnosis of acute myeloid leukaemia: French-American-British (FAB) classification

  7. Cytological criteria for the diagnosis of acute myeloid leukaemia: French-American-British (FAB) classification

  8. 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

  9. 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

  10. 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)

  11. Acute myeloid leukemiaApproximate frequency of organ infiltration

  12. 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)

  13. 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%

  14. 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!

  15. 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

  16. Acute myeloid leukemia Post-remission chemotherapy The aims of the intensification treatment: - elimination of residual disease • prolongation of the time of remission

  17. 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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