ACUTE MYELOID LEUKEMIA (AML)
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AML is a clonal malignancy of myeloid bone marrow precursors in which poorly differentiated cells accumulate in the bone marrow and circulation.
Signs and symptoms occur because of the absence of mature cells normally produced by the bone marrow, including granulocytes (susceptibility to infection) and platelets (susceptibility to bleeding). In addition, if large numbers of immature malignant myeloblasts circulate, they may invade organs and rarely produce dysfunction. There are distinct morphologic subtypes (Table 66-1) that have largely overlapping clinical features. Of note is the propensity of pts with acute promyelocytic leukemia (APL) (FAB M3) to develop bleeding and disseminated intravascular coagulation, especially during induction chemotherapy, because of the release of procoagulants from their cytoplasmic granules.
World Health Organization classificationa |
AML with recurrent genetic abnormalities |
AML with t(8;21)(q22;q22); RUNX1-RUNX1T1b |
AML with inv(16)(p13.1;1q22) or t(16;16)(p13.1;q22); CBFB-MYH11b |
Acute promyelocytic leukemia with t(15;17)(q22;q12); PML-RARAb |
AML with t(9;11)(p22;q23); MLLT3-MLL |
AML with t(6;9)(p23;q34); DEK-NUP214 |
AML with inv(3)(q21q26.2) or t(3;3)(q21;q26.2); RPN1-EVI1 |
AML (megakaryoblastic) with t(1;22)(p13;q13); RBM15-MKL1 |
Provisional entity: AML with mutated NPM1 |
Provisional entity: AML with mutated CEBPA |
AML with myelodysplasia-related changes |
Therapy-related myeloid neoplasms |
AML not otherwise specified |
AML with minimal differentiation |
AML without maturation |
AML with maturation |
Acute myelomonocytic leukemia |
Acute monoblastic and monocytic leukemia |
Acute erythroid leukemia |
Acute megakaryoblastic leukemia |
Acute basophilic leukemia |
Acute panmyelosis with myelofibrosis |
Myeloid sarcoma |
Myeloid proliferations related to Down syndrome |
Transient abnormal myelopoiesis |
Myeloid leukemia associated with Down syndrome |
Blastic plasmacytoid dendritic cell neoplasm |
Acute leukemia of ambiguous lineage |
Acute undifferentiated leukemia |
Mixed phenotype acute leukemia with t(9;22)(q34;q11,20); BCR-ABL11 |
Mixed phenotype acute leukemia with t(v;11q23); MLL rearranged |
Mixed phenotype acute leukemia, B/myeloid, NOS |
Mixed phenotype acute leukemia, T/myeloid, NOS |
Provisional entity: Natural killer (NK)-cell lymphoblastic leukemia/lymphoma |
French-American-British (FAB) classificationc |
MO: Minimally differentiated leukemia |
Ml: Myeloblastic leukemia without maturation |
M2: Myeloblastic leukemia with maturation |
M3: Hypergranular promyelocytic leukemia |
M4: Myelomonocytic leukemia |
M4Eo: Variant: Increase in abnormal marrow eosinophils |
M5: Monocytic leukemia |
M6: Erythroleukemia (DiGuglielmo’s disease) |
M7: Megakaryoblastic leukemia |
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AML is a clonal malignancy of myeloid bone marrow precursors in which poorly differentiated cells accumulate in the bone marrow and circulation.
Signs and symptoms occur because of the absence of mature cells normally produced by the bone marrow, including granulocytes (susceptibility to infection) and platelets (susceptibility to bleeding). In addition, if large numbers of immature malignant myeloblasts circulate, they may invade organs and rarely produce dysfunction. There are distinct morphologic subtypes (Table 66-1) that have largely overlapping clinical features. Of note is the propensity of pts with acute promyelocytic leukemia (APL) (FAB M3) to develop bleeding and disseminated intravascular coagulation, especially during induction chemotherapy, because of the release of procoagulants from their cytoplasmic granules.
World Health Organization classificationa |
AML with recurrent genetic abnormalities |
AML with t(8;21)(q22;q22); RUNX1-RUNX1T1b |
AML with inv(16)(p13.1;1q22) or t(16;16)(p13.1;q22); CBFB-MYH11b |
Acute promyelocytic leukemia with t(15;17)(q22;q12); PML-RARAb |
AML with t(9;11)(p22;q23); MLLT3-MLL |
AML with t(6;9)(p23;q34); DEK-NUP214 |
AML with inv(3)(q21q26.2) or t(3;3)(q21;q26.2); RPN1-EVI1 |
AML (megakaryoblastic) with t(1;22)(p13;q13); RBM15-MKL1 |
Provisional entity: AML with mutated NPM1 |
Provisional entity: AML with mutated CEBPA |
AML with myelodysplasia-related changes |
Therapy-related myeloid neoplasms |
AML not otherwise specified |
AML with minimal differentiation |
AML without maturation |
AML with maturation |
Acute myelomonocytic leukemia |
Acute monoblastic and monocytic leukemia |
Acute erythroid leukemia |
Acute megakaryoblastic leukemia |
Acute basophilic leukemia |
Acute panmyelosis with myelofibrosis |
Myeloid sarcoma |
Myeloid proliferations related to Down syndrome |
Transient abnormal myelopoiesis |
Myeloid leukemia associated with Down syndrome |
Blastic plasmacytoid dendritic cell neoplasm |
Acute leukemia of ambiguous lineage |
Acute undifferentiated leukemia |
Mixed phenotype acute leukemia with t(9;22)(q34;q11,20); BCR-ABL11 |
Mixed phenotype acute leukemia with t(v;11q23); MLL rearranged |
Mixed phenotype acute leukemia, B/myeloid, NOS |
Mixed phenotype acute leukemia, T/myeloid, NOS |
Provisional entity: Natural killer (NK)-cell lymphoblastic leukemia/lymphoma |
French-American-British (FAB) classificationc |
MO: Minimally differentiated leukemia |
Ml: Myeloblastic leukemia without maturation |
M2: Myeloblastic leukemia with maturation |
M3: Hypergranular promyelocytic leukemia |
M4: Myelomonocytic leukemia |
M4Eo: Variant: Increase in abnormal marrow eosinophils |
M5: Monocytic leukemia |
M6: Erythroleukemia (DiGuglielmo’s disease) |
M7: Megakaryoblastic leukemia |
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