Acute Myeloid Leukaemia Flashcards
What is Acute Myeloid Leukaemia (AML)?
A cancer of the primitive (immature) myeloid line of blood cells, affecting procussor cells for granulocytes, monocytes, erythrocytes, or platelets
In which age group is AML most common?
In the elderly, particularly those over 60 years old
What are the two main types of AML origins?
(1) De novo AML (new onset)
(2) Secondary AML (transformation from a myeloproliferative disorder)
What are the hallmark features of AML presentation?
Marrow failure symptoms, including
(1) anaemia
(2) infections
(3) bleeding
(4) easy bruising and petechiae (small red or purple spots)
Which AML subtype is associated with coagulation defects or disseminated intravascular coagulation (DIC)?
Acute promyelocytic leukaemia
In which AML subtypes is gum infiltration commonly seen?
Acute monocytic leukaemia and acute myelomonocytic leukaemia
What is the diagnostic threshold for blasts in acute leukaemia?
≥20% blasts in the peripheral blood or bone marrow
What characteristic feature is seen in AML blast cells on a blood film?
Auer rods inside the cytoplasm
Why is immunophenotyping important in diagnosing AML?
It is required for definitive diagnosis, as AML and ALL cells look similar
What tests are performed on a bone marrow aspirate in AML?
(1) Morphology
(2) Immunophenotyping
(3) Cytogenetics
What is the standard treatment approach for AML?
Multi-agent chemotherapy, typically 2-4 cycles, requires prolonged hospitalisation
What is a Hickman line used for in AML treatment?
Long-term central venous access during chemotherapy
What are the primary complications of AML itself?
(1) Anaemia: Causing fatigue and weakness.
(2) Neutropenia: Leading to severe infections, especially from gram-negative bacteria and fungi.
(3) Thrombocytopenia: Resulting in bleeding (purpura, petechiae)
What is the empirical treatment for neutropenic fever in AML?
Broad-spectrum antibiotics, particularly targeting gram-negative bacteria
What is Tumour Lysis Syndrome, and when does it occur?
A life-threatening condition caused by rapid cell breakdown, often during the first course of treatment
What are some late complications of AML treatment?
(1) Loss of fertility.
(2) Cardiomyopathy (e.g., from anthracyclines).
(3) Persistent infections like Pneumocystis jirovecii pneumonia (PJP)
How does myeloid leukaemia differ from lymphocytic leukaemia?
Myeloid leukaemia commonly arises from a myeloid precursor cell, such as neutrophils, however lymphocytic leukaemia arises from a lymphoid precursor, such as B-cells
What is the defining feature of acute leukaemia?
A block in differentiation at the precursor stage leading to a large number of malignant precursor cells accumulating in the bone marrow
A 30-year-old male presents with fatigue and bruising. Bone marrow biopsy shows the presence of large numbers of abnormal promyelocytes (neutrophil precursors) but very few mature neutrophils.
Cytogenetics reveal a t(15;17) translocation is also present.
Given the findings what is the most likely diagnosis. Explain why?
Acute Myeloid Leukaemia
= AML is characterised by a block in differentiation at a precursor stage leading to a large number of malignant pro-myelocytes accumulating in the bone marrow. This accounts for the bruising as patients with AML lack platelets, which hinders clotting
What are the clinical features of AML?
(1) Gum infiltration
(2) Disseminated intravascular coagulation (DIC) in acute promyelocytic leukaemia
(3) More common to see skin nodules
A 66-year-old male presents to the GP with shortness of breath on exertion and fatigue for the last few weeks. On examination, he has petechiae and splenomegaly.
Blood tests are ordered which show ↓haemoglobin (Hb), ↑white cell count (WCC), ↓platelets
He is referred to a specialist where a bone marrow biopsy is performed which shows high numbers of blast cells and Auer rods.
What is the most likely diagnosis?
Acute myeloid leukaemia (AML)
= mentions auer rods
Define Thrombocytopenia
low platelet count on a blood test
= Normal: 150,000–450,000/µL
(150–450 × 10⁹/L)
NICE advise considering an urgent FBC (within 48h) to assess for leukaemia in adults with any of the following -
Pallor
Persistent fatigue
Unexplained fever
Unexplained persistent or recurrent infection
Generalised lymphadenopathy
Unexplained bruising
Unexplained bleeding
Unexplained petechiae
Hepatosplenomegaly
A 63-year-old man presented with severe fatigue and recurrent bruising.
A bone marrow biopsy revealed hypercellularity and the presence of blasts (65%). For acute myeloid leukaemia, what is the cytogenetic abnormality?
t(15;17) translocation
What are the genetic mutations or chromosomal translocation found in patients with AML
1 - t(8;21)
2 - t(15;17)
= Associated with acute promyelocytic leukaemia (APL), a subtype of AML
Why is the normal range of lymphocytes and the absence of basophils and eosinophils important in differentiating between AML and CML?
The normal lymphocyte count and absence of basophils/eosinophils suggest AML, as CML typically shows elevated basophils and eosinophils
In a 71-year-old woman with myelodysplastic syndrome, unexplained fever, bruising, gum bleeding, and 25% blast cells with Auer rods on bone marrow aspirate, which is the most important prognostic factor?
(1) Cytogenetic type
= Key for prognosis in AML.
(2) Percentage of blast cells
= Higher blasts = worse prognosis.
(3) Performance status
= Affects treatment response.
(4) Age
= Older age worsens prognosis.
(5) Cell type (FAB classification)
= Less important than other factors.
A 52-year-old male patient presents to the general practitioner with a 4-week history of weight loss and malaise. He also reports discomfort in the left upper abdomen and abdominal fullness. There is no past medical history noted. He denies any recent travel.
On physical examination, a mass arises from the left upper quadrant, extending to the right iliac fossa. The mass has a palpable notch and a dull percussion note
Why wouldn’t auer rods be found?
AML typically presents in patients over the age of 65 with features caused by marrow infiltration (infection, anaemia, and bleeding)
Neutrophils are derived from what type of cell?
common myeloid progenitor cells
= Acute myeloid leukaemia
