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AM

• Aetiology: unclear association with

pre !e"isting myelodiplasia or

pri#ious chemotherapyradiation therapy

$en%ene e"posure

&own sy

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AM

• Morphological classi'cation

• renchAmerican$ritish system is based onthe degree of di-erentiation ! is a

morphological classi'cation• ,ytochemistry is based on

 – udan black stain

 – Myelopero"idase stain

 hese stains are positi#e in AM and negati#e A

2on speci'c esterase is positi#e monocyticsubtype

8/18/2019 Acute Leukemia Lecture

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AM

• 45 classi'cation correlatesmorphological genetic and clinicalfeature

• In this classi'cation the blastthreshold for the diagnosis AM is)/(*0+ blasts

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AM

• Immunophenotyping ! monoclonal antibody tocell surface antigen di-erentiate AM from A

• ineage in'delity: in some situation thee"pression of markers of more than one cellularlineage

• $iphenotypic leukemia

• ,ytogenetic analysis should be always

performed7 there are 3 groups – a#ourable reisk

 – Intermediate risk

 – 8oor risk

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AM

• Molecular analysis 9uorescence insitu hybridisation I4 and re#ersetranscriptase chain reaction !

8, 7 add sensiti#ity and precisionthe detection of translocationdeletions and aneoplodity in case

when cytogeenetics fails or gi#esnormal results

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AM

• ,linical features

• Acute presentation is usual oftencritically ill due to bone marrowfailure

• ymptoms of anemia: weakness 7letargy7 breathlessnesslightheadedness and palpitation

• Infections: chest7 mouth7 perianal7skin staphylococcus7 8seudomonas7

,andida

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8/18/2019 Acute Leukemia Lecture

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• In#estigation and diagnosis

• I4 and blood 'lm

• $one marrow aspirate and biopsy

• $one marrow cytogenetics

• Immunophenotyping of bone marrowblasts or blood blasts

•  otal $, usually increased with blastson blood 'lm but $, may be low

• 4$7 neurophils and platelets low

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8/18/2019 Acute Leukemia Lecture

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AM

• upporti#e treatment

• ;ood communication with patientand family

•  ransfusion platelet and $,

• 2eutropenic treatment

•

4ydration Allopurinol for pre#entinghypercalcemia

• ,entral #enous catheter

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AM

• eukemia is not detected bycon#entional morphological methodsbut may be demonstrated by more

sensiti#e molecular techniue

• , is not synonymous with cure

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•  reatment has 3 phases

• emission inductionusually 1* courses ofcombination ,

• ,onsolidation therapy to reduce leukemiaburden further and reduce the risk ofrelapse

• 5ptimum no of cycles *< with autologus or

allogenic sstem cell transplantation

• Maintenance therapy only when intensi#econsolidation can not be tolerated

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AM

• 8rognosis

• 60B0+ of pts aged > C0 will achie#e,

• elapse risk of pts 7 C0 withfa#ourable risk cytogentics is *@

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AM

• 8rognosis

• Age group >C0

•

eucocytic count at the presentation>*?"10@/ is fa#ourablre but when)100"10@/ is unfa#ourable

• 4istory od pre#ious mielodisplasia

•  some A$ subtype has fa#ourableprognosis

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