AML Flashcards
What is the epidemiology and aetiology/risk factors of AML?
Epidemiology
More common in men and diagnosis age 70
Aetiology
Myelodysplastic syndrome: increased risk
Down’s syndrome
Congenital neutropaenia
Fanconi anaemia
Radiation exposure
Previous administration of chemotherapy
Toxins: benzene and organochlorine insecticides
What is seen on blood film with AML?
Auer rods - Azurophilic structures seen in myeloid blasts
Also seen in myelodysplastic syndrome
What is diagnostic of AML on bone marrow aspirate/biopsy?
Myeloid blast count of > 20% (of 500 bone marrow cells).
Aspirate and biopsy samples are used for cytogenetics, immunophenotyping and flow cytometry
How is AML managed?
Initial management
Managed in specialist centres and offered any clinical trials if suitable
Education and support: coordinated by designated nurse
Supportive care: monitored for infections and coagulopathy
Cytoreduction
CNS involvement: started on intrathecal chemotherapy (cytarabine)
Tumour lysis syndrome: Should be anticipated, prophylaxis should be given
Chemotherapy or Haematopoietic stem cell transplantation
Induction and consolidation (and occasionally maintenance) stages
Allogenic stem cell transplant
When is cytoreduction done and how?
Patients with signs of leukostasis and WBC > 100 × 109/L
Hydroxycarbamide
How does an allogenic stem cell transplant work for AML?
Given myeloablative conditioning regimes (+/- total body irradiation) aimed at eliminating disease and allowing for a graft (the allo HCT) versus leukaemia reaction.
What are some poor prognostic indicators in AML?
Age (> 60)
Poor performance status
Multiple significant co-morbidities
Previous haematological disorders / dysplasia
Previous exposure to chemo/radio-therapy
Certain disease subtypes
What is the prognosis with AML if left untreated?
2 months
If treated 20% 5 year survival
