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Acute Myeloid Leukaemia. Dr. Soheir Adam, MRCPath Assistant Professor Department of Haematology, KAUH. Acute Myeloid Leukaemia. Definition - It is a clonal malignant disease, in which there is maturation arrest of the haemopoietic precursors at an early stage of development

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acute myeloid leukaemia

Acute Myeloid Leukaemia

Dr. Soheir Adam, MRCPath

Assistant Professor

Department of Haematology, KAUH

acute myeloid leukaemia1
Acute Myeloid Leukaemia
  • Definition

- It is a clonal malignant disease, in which there is maturation arrest of the haemopoietic precursors at an early stage of development

- It is characterized by the presence of > 20% blasts in the bone marrow

acute myeloid leukaemia2
Acute Myeloid Leukaemia
  • Pathophysiology

- The activation of abnormal genes through chromosomal translocations and other abnormalities

- Exposure to radiation e.g. high incidence of leukaemia among survivors of the atomic bomb in Japan

- Past exposure to chemotherapy:

Alkylating agents

Topoisomerase II inhibitors

- Antecedent haematological disorders:

myelodysplastic syndrome

myeloproliferative disease e.g. CML

myelodysplastic syndrome
Myelodysplastic Syndrome
  • A group of clonal disorders that are characterized by progressive cytopenias and dysplasia
  • Occurs mainly in elderly patients
  • The more severer forms ultimately progress to acute leukaemia
  • Usuaaly associated with chromosomal abnormalities in a large proportion of cases
acute myeloid leukaemia3
Acute Myeloid Leukaemia
  • FAB classification

MO AML with minimal differentiation

M1 AML without maturation

M2 AML with maturation

M3 Acute promyelocytic leukaemia

M4 Acute myelomonocytic leukaemia

M5a Acute monoblastic leukaemia


M6 Erythroleukaemia

M7 Acute megacaryoblastic leukaemia

acute myeloid leukaemia4
Acute Myeloid Leukaemia
  • Presentation

- Anaemia, bleeding and/or repeated infections

- Organ/skin infiltration specially in M5

- DIC specially in AML, M3

- Hyperleukostasis (headache, dizziness, blurring of vision)

acute myeloid leukaemia5
Acute Myeloid Leukaemia
  • Lab work up

- CBC and peripheral smear examination

- P.T., APTT, fibrinogen & D-dimers

- LDH, uric acid

- Urea and electrolytes


- Blood cultures

acute myeloid leukaemia6
Acute Myeloid Leukaemia
  • Lab work up

Bone marrow aspiration and trephine biopsy for:

- Morphology

- Cytochemical stains

- Immunophenotyping

- Cytogenetic analysis

acute myeloid leukaemia7
Acute Myeloid Leukaemia
  • Other investigations

- Chest X-ray


- MGA scan (cardiac toxicity of anthracycline chemotherapeutics)

acute myeloid leukaemia8
Acute Myeloid Leukaemia
  • Prognostic criteria

Cytogenetic abnormalities are the single most important prognostic factors in AML.

- Good prognostic abnormalities:

M3 t(15, 17)

M2 t(8,21)

M3 inv(16)

- Poor prognostic abnormalities

Monosomy 7

Monosomy 5

acute myeloid leukaemia9
Acute Myeloid Leukaemia


  • Induction and consolidation

- Combination of Anthracycline & Ara-C

- A total of 3 to 5 courses

  • Late intensification

- High dose Ara-C in young good risk group

- Matched All-BMT in fit, bad risk fit

- Mini-allo BMT or autologus BMT in older patients

acute myeloid leukaemia10
Acute Myeloid Leukaemia
  • Management

- About 50% of patients achieve CR after first course

- Another 10% enter remission after 2nd course

acute promyelocytic leukaemia
Acute Promyelocytic Leukaemia
  • Clinical presentation

- Younger age on presentation as compared to other AML subtypes

- Often patients have low counts on presentation

- Bone marrow has >30% promyelocytes

- It is commonly associated with DIC which is the main reason for early deaths

- Aggressive replacement with platelets and cryoprecipitate is the mainstay of early management

acute promyelocytic leukaemia1
Acute Promyelocytic Leukaemia
  • T(15,17) is a good prognostic indicator and is present in 95% of cases
  • This translocation involves the retinoic acid receptor gene rendering the tumor cells susceptible to all-trans retinoic acid (ATRA)
  • CR achieved in >90% of cases with ATRA and chemotherapy