Acute myelocytic leukemia (AML)

n/n

anemia is …

adults

AML affects this age group

WHO classifications of AML

-w recurrent genetic abnormalities (specific)

-w myelodysplastic changes

-therapy related

-not otherwise categorized (FAB)

-myeloid prolif associated with Down’s syndrome

-ambiguous origin

dec

PLTs inc/dec

>20

x% blasts or genetic abnormalities

AML with t(8;21);RUNX1/RUNX1T1

-5-10% cases

-Aurer rods

-pesudo Pelger-Huet

-children and young adults

AML with inv(16);CBFB-MYH11

-myelomonocytic

-eosinophilia with dysplastic changes

-young adults

eosinophils

predominant cell type in AML with inv(16);CBFB-MYH11

AML with t(15;17);PML-RARA

-abnormal promyelocytes with Aurer rods

-DIC (primary granules)

-treat with ATRA

promyelocytes

predominant cell type in AML with t(15;17);PML-RARA

AML with t(9;11);KMT2A-MLLT3

-monoblasts

-children

-DIC

monoblasts

predom cell type in AML with t(9;11);KMT2A-MLLT3

AML with t(6;9);DEK NUP214

-multilineage dysplasia

-basophilia

basophils

predom cell type in AML with t(6;9);DEK NUP214

AML with inv(3);GATA2-MECOM

-may evolve from MDS

-dysmegakaryocytopoiesis

megakaryocytes (PLTs)

cell type affected in AML with inv(3);GATA2-MECOM

AML with t(1;22);RBM15-MKL1

-megakaryoblastic

-infants

megakaryoblasts

predom cell type in AML with t(1;22);RBM15-MKL1

AML with myelodysplastic-related changes

-older adults

->20% blasts

-poor prognosis

-MDS history

-multilineage dysplasia

therapy related

-years after chemo/radiation for AML and MDS

-alkylating agents, radiation, topoisomerase II inhibitors

-poor prognosis

AML not otherwise categorized

-grouping based on morphology, glow, cytochemical rxns

-includes FAB classification

AML with myeloid proliferation associated with Down’s syndrome

-associated with trisomy 21

-infantile

AML without differentiation (M0)

-CD13, 33, 34, 117

-no aurer rods

-no evidence of myeloid differentiation

-very very immature cells

AML with minimal maturation (M1)

-CD13, 33, 34, 117

-poorly differentiated blasts >90% non erythroid cells in BM

->3% blasts myeloperoxidase pos

-Aurer rods

AML with maturation (M2)

->20% blasts

->10% maturing neutrophilic cells

-CD13, 15, 33, 34, 117, HLA-DR

-Aurer rods

AML with acute promyelocytic leukemia (M3)

-FAB

-AML with t(15;17);PML-RARA

AML with acute myelomonocytic leukemia (M4)

-monocytic cells >20% of WBCs

-neutriphilic maturation >20% of WBCs

-inc lysozyme

-CD4, 11b, 13, 14, 33, 64

AML with acute monocytic and monoblastic leukemia (M5)

->80% BM and PB cells monocytic

-CD4, 11b, 14, 64

-organ (gums) and CNS

AML with pure erythroid leukemia (M6)

->80% BM cells erythroid

->30% erythroblasts

-dysplastic features

AML with acute megakaryocytic leukemia (M7)

-cytopenia

->20% blasts of at least 50% megakaryocyte origin

-CD41, 61