Acute Myeloid Leukaemia

Question 1

What increases risk of AML?

Answer 1

Trisomy 21

Genetics

• FTL3
• NPM1

Question 2

What cell is affected in AML?

Answer 2

Myeloid progenitors

Question 3

Pathology?

Answer 3

Mutation in myeloid progenitor - doesn't differentiate
->
accumulation of blasts that can't differentiate
->
Secretion of inhibitory chemokines
->
Inhibition of normal haematopoeisis 
->
Bone marrow failure

Question 4

Typical presentation?

Answer 4

” 58 y/o man presents with tiredness and bruising on his legs. He complains of aching bones and a low grade fever. O/e he has petechiae on his legs. His lymph nodes are non-palpable but he has HSM. “

Question 5

Symptoms?

Answer 5

High cell turnover

Blood cytopenias

• Thrombocytopenia (petechiae)
• Neutropenia - repeated infection
• Infiltrates (gum hypertrophy)

Question 6

Investigations?

Answer 6

FBC

• Neutropenia
• Thrombocytopenia

Peripheral film
- Presence of blasts

Bone marrow biopsy

Question 7

What is present in the blasts in AML?

Answer 7

Auer rods

Question 8

What blasts are found in acute promyelitic leukaemia?

Answer 8

Bi-lobed nuclei

Hypergranular

Question 9

What percentage of bone marrow is filled with myeloid blasts?

Answer 9

> 20%

Question 10

Treatment for AML?

Answer 10

Anti-leukaemic chemo

HSCT

Question 11

What novel monoclonals are there for AML?

Answer 11

Gemtuzumab

Question 12

Treatment for APML?

Answer 12

All trans retinoic acid

Question 13

What drug can be given prophylactically in AML chemo and why?

Answer 13

Allopurinol

Increased risk of tumour lysis syndrome