AML Flashcards
Epidemiology
More common in men
Median age of diagnosis 69
Pathophysiology
Arise from single leukemic cell–>expands and acquires additional mutation–>proliferation resulting in monoclonal population of leukemic cells
Failure to maintain balance between proliferation and differentiation
Leukemic cells have growth advantage–>crowd out normal cells
Secondary AML Risk Factors
From other disease
Treatment related: Alkylating agents, Topoisomerase inhibitors
Primary AML Risk Factors
Genetic predisposition
Environmental carcinogens
Presentation
Anemia
Neutropenia
Thrombocytopenia
Bone pain
Gum hypertrophy
Diagnosis
Bone Marrow Biopsy: GREATER THAN 20% BLASTS
Favorable risks
Cytogenic’s: Core binding factor abnormalities t(8;21)
Gene mutation: Mutated NPM1, Double CEBPA
Intermediate risks
Cytogenic’s: Normal, trisomy 8
Gene mutation: Mutated NPM1 + FLT3-ITD, FLT3-ITD without other changes
Poor/Adverse risks
Cytogenetics: Complex (>3), deletions, 11q23, inversion 3
Gene mutation: FLT3-ITD with other abnormalities
FLT3 mutations
midostaurin, quizartinib, gilertinib
Treatment
Induction: Goal is remission
Consolidation: Goal is to prevent relapse
Intensive Induction eligible
Continuous infusion cytarabine + anthracycline
Venetoclax + hypo-methylating agent
Intensive induction ineligible
Venetoclax + hypo-methylating agent
Hypo-methylating agents; lower dose chemotherapy
Supportive care
Blood products, prophylactic anti-infective, hydroxyurea
Symptomatic management
Intensive chemotherapy 7+3
Cytarabine 100-200 mg/m^2/day for 7 straight days
Anthracycline for 3 days: Idarubican or Daunrubicin
