FN: Acute Myeloid Leukaemia

Question 1

Epi

Answer 1

Increased risk w/ age: mean 65-70

Commonest acute leukaemia of adults

Question 2

Aetiology

Answer 2

Neoplastic proliferation of myeloblasts

Question 3

Risk factors

Answer 3

1. Chromosomal abnormalities
Radioation
Downs
Chemotherapy e.g. for lymphoma
Myelodysplastic and myeloproliferative syndromes

Question 4

Classification

Answer 4

FAB classification

Question 5

FAB classification

Answer 5

M2: granulocyte maturation
M3: acute promyelocytic leukaemia t(15;17)-DIC
M4: acute myelomonocytic leukaemia
M7: megakayoblastic leukaemia trisomy 21

Question 6

Features

Answer 6

BM failure
Infiltration
Blood

Question 7

BM failure

Answer 7

Cytopenias

Question 8

Infiltration

Answer 8

GUM infitration - hypertrophy and bleeding (M4)
HSM
Skin involvement
Bone pain

Question 9

Blood

Answer 9

DIC: APML (M3)
Hyperviscosity: very high WCC may - thrombi

Question 10

Investigations

Answer 10

1. Raised WCC blasts (occasionally normal)
2. Anaemia and reduced platlets
3. BM aspirate

Question 11

BM aspiration shows

Answer 11

20% blasts

Auer rods are diagnostic

Question 12

Diagnosis

Answer 12

Made by immunological and molecular phenotyping - flow cytometry

Cytogenetic analysis affects Rx and guides prognosis

Question 13

Management

Answer 13

Supportive: as for AML
Infections: as for ALL

Question 14

Chemotherapy

Answer 14

V. intensive - long periods of neutropenia and reduced platelets
M3 ATRA for APML

Question 15

BMT

Answer 15

Allogenic if poor prognosis

1. Destroy BM and leukaemia cells with chemotherapy and total body irradiation
2. Repopulate marrow with HLA - matched donor HSCs

Autologous if intermediate prognosis - HSCs taken from pt.