Acute myeloid leukaemia (AML)

Acute myeloid leukaemia is the more common form of acute leukaemia in adults. It may occur as a primary disease or following a secondary transformation of a myeloproliferative disorder.

Features are largely related to bone marrow failure:

• anaemia: pallor, lethargy, weakness
• neutropenia: whilst white cell counts may be very high, functioning neutrophil levels may be low leading to frequent infections etc
• thrombocytopenia: bleeding
• splenomegaly
• bone pain

subtypes: M0 to M7

Poor prognostic features

• 60 years

• 20% blasts after first course of chemo

• cytogenetics: deletions of chromosome 5 or 7

Acute promyelocytic leukaemia M3

• associated with t(15;17)

• fusion of PML (promyelocytic leukemia) and RAR-alpha genes

  (The gene for retinoic acid receptor alpha from chromosome 17 is transferred to chromosome 15 in a location adjacent to the PML gene)

• presents younger than other types of AML (average = 25 years old)

• DIC or thrombocytopenia often at presentation

• give all-trans-retinoic acid (ATRA)

• good prognosis