Acute Myeloid Leukaemia

Question 1

Definition of acute myeloid leukaemia

Answer 1

Is a life-threatening haematological malignancy caused by proliferation of myeloid blasts in the bone marrow, peripheral blood and extramedullary tissues

Question 2

Aetiology/Pathophysiology of acute myeloid leukaemia

Answer 2

• Is the most COMMON acute leukaemia in ADULTS
◦ Incidence INCREASES with age

• Due to maturation arrest and the proliferation of myeloid blasts, there would be a decrease in the number of mature neutrophils, RBCs and/or platelets.
◦ This would result in BONE MARROW FAILURE (manifests as anaemia, neutropenia and/or thrombocytopenia)

Question 3

Risk factors for acute myeloid leukaemia

Answer 3

• Age >65
• Radiation exposure
• Long term chemotherapy complication
• Chromosomal abnormalities (e.g Down’s syndrome, Klinefelters syndrome etc)

Question 4

History and Examination of acute myeloid leukaemia

Answer 4

• Bone marrow failure:
◦ Anaemia:
• pallor
• Lethargy/fatigue
• Dizziness
• Dyspnoea
• Palpitations
◦ Infection/Fever: likely due to neutropenia
◦ Bleeding: due to thrombocytopenia
• Ecchymosis or petechiae
• Mucosal bleeding
• DIC

• Organ infiltration:
◦ Hepatosplenomegaly
◦ Lymphadenopathy
◦ Gum hypertrophy
◦ Bone pain
◦ Skin involvement

Question 5

Investigations for acute myeloid leukaemia

Answer 5

• FBC: Likely to see anaemia, neutropenia and thrombocytopenia (however, WBC count may be evaluated, but there would till be severe neutropenia)
• Blood film: Likely to see myeloid blast cells with Auer rods
• Bone marrow aspirate and trephine biopsy: likely to see myeloid blast cells in the bone marrow
• Coagulation pathway: should be normal, if affected, then suspect DIC

Question 6

Treatment of acute myeloid leukaemia

Answer 6

1) Chemotherapy: Induction therapy should be started. Should try to aim for remission. Very intensive which can lead to bone marrow suppression with neutropenia and thrombocytopenia

+ Supportive care: hydration, RBC/platelet transfusion may be needed

Consider bone marrow transplant

Question 7

Prevention and prognosis of acute myeloid leukaemia

Answer 7

• Can take antibiotic, antifungal and/or antiviral prophylaxis during therapy

Can progress rapidly if not treated
Cure rate is 35-40%
Prognosis worsens with increasing age

Question 8

Complications of acute myeloid leukaemia

Answer 8

• Tumour lysis syndrome: ontological emergency, would result in electrolyte (hyperuracaemia) and metabolic disturbances and renal impairment
• Infection
• Neutropenia
• DIC
• Leukostasis: if WCC very high