Acute Myelogenous Leukemia: Learning Objectives
Medical Importance
The acute leukemias are aggressive malignancies that originate in a hematopoietic stem cell and are rapidly fatal without immediate treatment. A significant portion of patients with acute myelogenous leukemia (AML) can now be cured with chemotherapy. Others can be cured with stem cell transplantation. As with acute lymphoblastic leukemia, the successful management of patients with AML requires a therapeutic strategy determined by careful assessment of individual prognosis, aggressive supportive therapy, and early recognition and treatment of complications.
Objectives
- Define "myeloblast" and describe the consequences of excess myeloblasts in the bone marrow and in the circulation. Name at least three disease features which result from replacement of marrow cells with myeloblasts or circulation of myeloblasts.
- Describe the predominant cell types seen in the peripheral blood and/or bone marrow in each of the four major categories of leukemia (AML, ALL, CML, CLL).
- Describe the unique features of acute promyelocytic leukemia (AML M3), including the morphologic appearance of the promyelocyte, hemorrhagic complications, chromosomal abnormality, and treatment with induction therapy and all trans retinoic acid.
- Name two favorable and two adverse cytogenetic abnormalities in AML.
- Therapy of AML commonly consists of an induction phase, followed by a consolidation phase. Be able to describe the principle goals of each phase of therapy. Be able to state the approximate success rate of chemotherapy for AML (rate of complete remission with induction chemotherapy and cure rate).
- Be able to identify the complications of induction chemotherapy for AML. Name which complications contribute to mortality.
- Compare and contrast AML and ALL in terms of age of patients, central nervous system involvement, treatment, and outcome.
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