Cancer of the myeloid line of blood cells (progenitor cell for granulocytes, monocytes, erythrocytes or platelets)

Aetiology

• More common in the elderly (>60 years)
• Often associated with myelodysplastic syndromes but can arise ‘de novo’

Clinical features

• Similar to ALL (marrow failure)
• Subgroups of AML may have characteristic presentation
  • Coagulation defect/DIC in acute promyelocytic leukaemia
  • Gum infiltration most commonly seen in acute monocytic leukemia and acute myelomonocytic leukemia

Investigations

• Bloods:
  • Blood count and film: reduction in normal cells, presence of abnormal cells (‘blasts’) - large size, high nuclear:cytoplasmic ratio, prominent nucleolus
    • By definition an acute leukaemia involves an excess of ‘blasts’ (>/=20) in either the peripheral blood or bone marrow
    • Blast cells have rods inside their cytoplasm that are named Auer rods
  • Coagulation screen
• Bone marrow aspirate:
  • Morphology
  • Immunophenotype
  • Cyto/molecular genetics - diagnostic utility, prognostic significance
  • Trephine - enables better assessment of cellularity and is helpful when aspirate is sub-optimal

Management

• Multi-agent chemotherapy
  • Between 2-4 cycles of chemotherapy
  • Prolonged hospitalisation
  • Targeted treatments in subsets
  • Hickman line used to provide long-term central venous access

Complications

• Same as for ALL