Acute Myeloid Leukemia
Terms
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- Is AML lymphoid?
- no. duh
- Cells lines that could be AML
- Granulocytes, monocytes, erythrocytes, megaloblasts, or combo
- What percent of acute leukemias are AML?
- 70%
- Etiology of AML
- 98-99% Idiopathic
- AML morphology
- -20% more blasts in PB or BM
- PB in AML looks like?
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-thrombocytopenia +/- anemia
-WBC variable (high d/t blasts or no blasts in pb, depends) - BM in AML looks like?
- Hypercellular and monomorphic population of blasts
- Clinical presentation of patients with AML
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-Symptoms of BM failure
-easy bleeding/bruising
-thrombocytopenia
-fatigue and pallor from anemia
-fever and infections from neutropenia - is AML aggresive?
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VERY AGGRESSIVE
remission w/ chemo, but only 25% 5 yr survival - Things that make AML prognosis worse
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-secondary to MDS or previous chemotherapy
-Advanced age, extremely high WBC count - Cytogenics of AML
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Usually CD34 positive
Myeloid markers-CD13, CD33, MYELOPEROXIDASE - Cytogenics of ALL
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usually CD 34 positive
Lymphoid markers-CD10+, T&B cell markers, TdT - Auer rods
- Myeloperoxidase crystals
- What do Auer rods mean?
- These mean AML (or some granulocytic differentiation)
- What does NO auer rods mean?
- it could be AML or ALL... Can't differentiate without cytogenetics
- M0
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-Minimally differentiated AML
-Myeloid antigens-CD13+, CD33+ - M1
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AML without differentiation
myeloperoxidase positive, CD33+,CD13+, Could have auer rods - M2
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AML with maturation
-Most common type of AML
-Full range of granulocyte precursors, but blast >20%
-CD13+, Myeloperoxidase positive, usually with Auer rods - M3
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Acute Promyelocytic Leukemia
-Most BM cells are hypergranular promyelocytes and myeloblasts
-Many Auer rods
-Younger patients (35-40)
-Often have DIC
-t(15:17) - M4
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Acute Myelomonocytic Leukemia
-Myeloblasts plus monocytes
-Myelo-CD13+, Myeloperoxidase+, auer rods, maybe
MONO-CD14+, CD64+, Non-specific esterase+, myeloperoxidase- - M5
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Acute Monoblastic Anemia
-elderly patients, more tissue infiltration than other aml
-CD14+, CD64+, non-specific esterase, myeloperoxidase-, auer rod-
M5a-les mature M5b-more mature - M6
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Acute erythroleukemia
-Myeloblasts>20%, but dysplastic erythroid precursors more than half of BM cells, often with ring shaped perinuclear vacuoles
usually profound anemia, but numerous precursors in PB (dysplastic) - M7
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Acute Megakaryocytic Leukemia
Blasts of megakaryocytic lineage, CD41a+, Platelet-specific AB against GPIIb/GIIIa or VWF
-inc BM fibrosis
-Inc incidince with Down Syndrome - M3 cytogenicis
- t(15:17) -- with this, long-term prognosis is favorable
- AML M4 EOS
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AML subtype with abnormal eosinophil precursors
-inv 16
-favorable prognosis