Acute Myeloid Leukemia
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| Acute Myeloid Leukemia (AML) Overview ? | * A tumor of hematopoietic progenitors caused by acquired oncogenic mutations ...... * cause bone pain due to the hyperproliferation..... * can be caused by the treatment of other malignancies (breast cancer)
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| AML Dx in bone marrow ? | * based on 20% blasts in bone marrow
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| AML testing ? | * CD34 is stem cell marker
...... * flow cytometry and FISH
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| AML Classification ? | * FAB classification
--M0
--M1
--M2
--M3, M3v
--M4
--M5a, M5b
--M6a, M6b
--M7
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| AML Morphology ? | * see 20% of blasts in bone marrow or peripheral blood.... * Myeloblasts - see Auer Rods and are MPO+ ..... * Monoblasts - no Auer Rods and are NSE+
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| AML M0 ? | * M0 = minimally differentiated ..... * Acute myeloblastic leukemia...... * MPO & Sudan Black B (SBB) negative ....... * CD13, CD33, CD117 – all myleoid markers
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| AML M1 ? | * Acute myeloid leukemia without complete maturation ...... * MPO+, SBB+ staind ..... *CD13, CD33, CD117, MPO, CD34, HLA-DR +
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| AML M3 (APL) ? | * Acute Promeylocytic Leukemia..... * >20% Promyelocytes in BM..... * see bundles or Auer Rods = faggot cells .... * HLA-DR(-); CD33+, CD34(-)..... * translocxations at t(15;17) --> to PML-RARa ....... * high incidence of DIC (clot and bd at same time)
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| AML M4 ? | * Acute Myelomonocytic Leukemia ..... * see typical myeloblasts and monoblasts are large and blue..... * see hypercellular bone marrow .... * CD13, CD33, CD14, CD4, C11c + ..... * translocation at t(11q23;v) diverse MLL fusion gene
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| AML M4eo ? | * Acute Myelomonocytic leukemia in younger pts. .... * Same as M4 but with eosinophils at all stages of maturation containing abnormally large purple-violet granules .... * CD2 + also..... * Inversion of (16)(p13q22)
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| AML M2 ? | * translocation of(8;21)(q22;q22) – CBFa/ETO fusion gene --- ETO = 8 21
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| AML M5 ? | * Acute Monoblastic (M5a) and Monocytic (M5b) leukemia ..... * see MPO(-); NSE+..... * see translocation t(11q23;v) – diverse MLL fusion gene
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| AML M6 ? | * Acute Erythroleukemia (DiGuglielmo Disease) .... * see Dysplastic erythroid precursors .... * stains are Ringed sideroblasts with Prussian blue; PAS+ in globular or diffuse.... * immunophenotype = Glycophorin A and Hemoglobin A in erythroid elements
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| AML M7 ? | * Acute Megakaryoblastic leukemia ..... * Cytoplasm blue , agranular with pseudopod formation .... * EM – platelet peroxidase +
.... * Immunophenotype – CD41 (IIb/IIIa)+, CD61 (IIIa)+, CD42 (Ib) variable..... * most common AML in Downs Syndrome
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| AML with MDS-like Features ? | * meets at the feaures of MDS, but the blast ratio is > 20%, which is AML.... * poor prognosis
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| AML Therapy Related ? | * poor prognosis... * Alkylating therapy or radiation .... * Topoisomerase II inhibitor (etoposide)- see Translocations involving MLL (11q23)
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| AML Clinical ? | * Symptoms related to thrombocytopenia, anemia and neutropenia
....* Fever, fatigue, spontaneous bleeding, petechiae and bruising, guu bleeding, and infections.... * no CNS involvement
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| Most common AML when the gums bleed ? | * M4 and 5
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| Process of Dx AML ? | * blood to see if >20% blasts --> see if MPO is + or - --> Flow cytometry if MPO + = CD13, CD33, HLA-DR and if MPO - = CD10, CD19, or CD2, CD3, CD5 + (ALL)
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