Acute Myeloid Leukemia AML:Classification,Diagnosis,Prognostic Factors

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Results

ACUTE MYELOID LEUKEMIA

Related topics

Introduction and Clinical Features

Treatment and Future Hold For AML

Dr Ira Shah
M.D, DCH(Gold Medalist), FCPS, DNB
Edited by Dr. Bharat R Agarwal
Consultant Pediatric Hematologist and Oncologist.

Q. How is AML classified?

A. The French-American-British classification system divides AML into 7 types -

M1 - Acute myeloblastic leukemia without maturation.
M2 - Acute myeloblastic leukemia with maturation.
M3 - Acute promyelocytic leukemia.
M4 - Acute myelomonocytic leukemia
M5 - Acute monocytic leukemia
M6 - Acute erythroleukemia
M7 - Acute megakaryocytic leukemia

M0 category is not officially recognized as part of AML as it lacks definitive myeloid differentiation by morphology or conventional cytochemistry but shows evidence of AML by ultrastructural or immunophenotyping.

Identification of AML subtypes is important because several new drugs have more activity against some variety of AML as against others. Also, prognosis and some clinical features may differ considerably among various AML sub-types.

Q. How is AML diagnosed?

A. On clinical suspicion, a complete hemogram and peripheral smear examination should be done which may aide in suspicion of leukemia in most cases. Peripheral WBC count may be increased, decreased or normal with equal frequency. Granulocytopenia is common. Thrombocytopenia, with a platelet count <20,000/ul is also common. Hematocrit is generally low.

Bone marrow aspiration and examination is usually diagnostic. Bone marrow biopsy may be required to assess cellularity. AML is diagnosed when bone marrow has more than 30% blasts. The bone marrow aspirate is stained with special histochemical stains to distinguish between AML and ALL and to confirm their diagnosis. The stains most commonly used include myeloperoxidase, PAS, Sudan Black B and esterase. (ALL stains with only PAS).

Bone marrow aspirate should also be sent for karyotyping and immunophenotyping as it helps in both type-classification and prognosis.

AML can also be diagnosed by biopsy of a chloroma. In addition, base line biochemical profile, X-Ray chest, coagulation screen and CSF examination are required.

Q. What are the prognostic factors in AML?

A. The various unfavorable factors are -

Hyperleukocytosis (WBC count > 1,00,000/cumm)
Secondary AML/MDS.
Monosomy 7 or 7q-
Aneuoploidy
Trisomy 8
Abnormalities of Chromosome 11 at band q23.
FAB type M7.

The favorable factors include.

FAB type M2 ,M3 , M4
Inversion of chromosome 16.
Reactivity with CD2 (T1).
T (8;21) and T (15;17) abnormality

Next : Treatment and Future Hold For AML

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