Acute myeloid leukemia

Acute myeloid leukemia
Updated: 08/31/2022
© Jun Wang, MD, PhD

General features
  • Clonal proliferation of myeloid precursors
  • Lack of differentiation
  • Classification based on lineage and differentiation of neoplastic cells
  • Most common acute leukemia in adults
  • More common in developed countries, Caucasian and older population
Clinical presentations
  • Symptoms associated with marrow suppression
  • Fatigue due to anemia
  • Infections, especially opportunistic infections due to abnormal white cell functions
  • Bleeding due to platelet malfunction
Key risk factors
  • Previous hematologic disorders, such as MDS
  • Congenital disorders, such as Down’s syndrome
  • Radiation, benzene, smoking
  • Radiation therapy, chemotherapy, etc
Key Laboratory findings
  • Myeloblasts or immature myeloid cells, such as promyelocytes or promonocytes more than 20%
  • Myeloblasts 
    • Positive: CD33, CD34, CD117, myeloperoxidase, low TdT
    • Negative: CD3, CD5, CD19
Classifications
  • AML with recurrent genetic abnormalities
AML with t(8;21)(q22;q22.1);RUNX1-RUNX1T1
AML with inv(16)(p13.1q22) ort(16;16)(p13.1;q22);CBFB-MYH11
APL with PML-RARA
AML with t(9;11)(p21.3;q23.3);MLLT3-KMT2A
AML with t(6;9)(p23;q34.1);DEK-NUP214
AML with inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOM
AML (megakaryoblastic) with t(1;22)(p13.3;q13.3);RBM15-MKL1
Provisional entity: AML with BCR-ABL1
AML with mutated NPM1
AML with biallelic mutations of CEBPA
Provisional entity: AML with mutated RUNX1
  • AML with myelodysplasia related changes
  • Therapy related acute myeloid leukemia
  • AML not otherwise categorized: Including original FAB classification without M3, which is currently classified as APL with PML-RARA
AML, minimally differentiated (FAB M0): Nongranular blasts; less than 3% of blasts express myeloperoxidase
AML without maturation (M1): >90% blasts, >3% among which express myeloperoxidase
AML with maturation (M2): >20% myeloblasts, monocytic precursors < 20%, granulocytes > 10%+
Acute myelomonocytic leukemia (M4): >20% myeloblasts, monoblasts and promonocytes
Acute monoblastic/monocytic leukemia (M5): 80% or more nonerythroid bone marrow cells are monocyte lineage (monoblasts, promonocytes and monocytes)
Pure erythroid leukemia (M6): >50% erythroid lineage and > 20% myeloblasts of nonerythroid cells (M6a); > 80% erythroid lineage with no significant myeloblastic component (M6b)
Acute megakaryoblastic leukemia (M7): > 20%+ blasts,  50%+ are megakaryocytic (Express GPIIb/IIIa or vWF)
Acute basophilic leukemia
Acute panmyelosis with myelofibrosis
  • Myeloid sarcoma
  • Myeloid proliferations related to Down syndrome
Transient abnormal myelopoiesis (TAM)
Myeloid leukemia associated with Down syndrome

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