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Chapter 24 Acute Myeloid Leukemias (AML)

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MLAB 1415: Hematology Keri Brophy-Martinez. * * * * * * * * * * * * * * * * Also known as Acute myelocytic leukemia Acute myelogenous leukemia Acute nonlymphocytic ... – PowerPoint PPT presentation

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Title: Chapter 24 Acute Myeloid Leukemias (AML)


1
Chapter 24 Acute Myeloid Leukemias (AML)
  • MLAB 1415 Hematology
  • Keri Brophy-Martinez

2
Overview of AML
  • Also known as
  • Acute myelocytic leukemia
  • Acute myelogenous leukemia
  • Acute nonlymphocytic leukemia
  • Stem cell disorder characterized by malignant
    neoplastic proliferation and accumulation of
    immature and nonfunctional hematopoietic cells in
    the bm
  • Neoplastic cells show increased proliferation
    and/or decreased cell death(apoptosis)
  • Effect is expansion of the neoplastic clone with
    a decrease in normal cells

3
Overview of AML
  • All acute leukemias begin BEFORE clinical signs
    and symptoms occur
  • As the tumor volume expands, normal functional
    marrow cells decrease
  • Characterized by two major features
  • Ability to proliferate continuously
  • Due to mutations affecting growth factors
  • Transcription errors
  • Arrested development of normal cells

4
eTIOLOGY
  • Classified by the cellular appearance of the
    primary stem cell
  • Common myeloid progenitor (CMP)
  • AML or ANLL
  • Common lymphoid progenitor (CLP)
  • ALL

5
Clinical findings
  • CLASSIC TRIAD
  • Anemia
  • Infection
  • Bleeding/easy bruising/petechiae
  • Fever
  • Shortness of breath
  • Fatigue
  • Weight loss

6
Lab Features peripheral blood
  • WBC count
  • variable at diagnosis
  • ( 1-100 x 109/L)
  • gt20 blasts present
  • Auer rods fused primary granules in myeloblasts
  • RBCs
  • Decreased
  • Hgb lt 10g/dL
  • Inclusions reflect rbc maturation defects
  • Howell-Jolly, Pappenheimer, basophilic stippling
  • nRBCs present
  • Platelets
  • Decreased
  • Hypogranular, giant forms
  • Megakaryocyte fragments

7
Myeloblast with Auer rods

8
Lab Features bone marrow
  • Hypercellular
  • Decreased fat content
  • gt20 nonerythroid blasts
  • Fibrosis

9
FAB Classification of acute leukemia
Morphology MPO SBB Specific esterase Nonspecific esterase PAS
M0 Acute myeloblastic leukemia mimally differentiated gt30 blasts No granules Not present Not present Not present Not present Not present
M1 Acute myeloblastic leukemia with no maturation gt30 blasts Few granules /- Auer rods Present Present Can be Present Not present Not present
M2 Acute myeloblastic leukemia with maturation gt30 blasts Granules common Auer rods Present Present Can be Present Not present Not present
M3 Acute promyelocytic leukemia gt30 blasts Prominent granules Auer rods Faggot cells Present Present Present Not present Not present
M4 Acute myelomonocytic leukemia gt30 blasts gt20monocytes Auer rods Present Present Present Present Not present
M4 eo Acute myelomonocytic leukemia With eosinophilia gt30 blasts gt20monocytes gt5 abn eos Auer rods Present Present Present Present Not present
M5 Acute monoblastic leukemia with or withour maturation gt30 blastsgt80 monocytes with/without differentiation Can be Present Can be Present Can be Present Present Not present
M6 Acute erythroleukemia gt30 myeloblasts gt50 megaloblasts Auer rods Present Myeloblasts Present Myeloblasts Present Myeloblasts Not Present Present Erythroblasts
M7 Acute megakaryocytic leukemia gt30 Megakaryoblasts Cytoplasmic budding Not present Not present Can be Present Not present Not present
10
Who Classification of acute leukemia
  • AML with recurrent genetic abnormalities
  • AML with multilineage dysplasia
  • AML and MDS- therapy related
  • AML- not otherwise categorized

11
WHO Classification of Acute Myelocytic Leukemias
12
M1 AML without maturation
  • Myeloblast with Auer rod
  • High NC ratio
  • Fine chromatin
  • Prominent nuclei

13
M2 Aml with maturation
  • All stages of neutrophil maturation
  • gt20 myeloblasts
  • Auer rods common

14
M3 promyelocytic leukemia (faggot cell)
  • Faggot cells with bundles of Auer rods
  • Genetic translocation t(1517)
  • Hypergranulation

15
M4 Acute myelomonocytic leukemia (AMML)
  • Monoblasts and promonocytes seen
  • Some neutrophil precursors seen
  • Vacuolization often seen

16
M5 Acute monoblastic leukemia
  • Monoblasts
  • Hemophagocytosis
  • Nuclear lobulation

17
M6 Acute erythroid leukemia
  • Striking poik
  • High number of RBC precursors
  • gt20 Myeloblasts

18
M7 Acute Megakaryoblastic Leukemia
  • Peripheral blood
  • May see micromegakaryoblasts
  • Megakaryocyte fragments
  • Cytopenias
  • Dysplastic segmented neutrophils and platelets
  • Bone marrow
  • Often get dry tap
  • Fibrosis

19
Prognosis of all amls and therapy
  • Death often occurs from infection and hemorrhage
    in weeks to months unless therapy is started
  • Chemotherapy
  • Reduces tumor load
  • Bone marrow transplants

20
References
  • McKenzie, Shirlyn B., and J. Lynne. Williams.
    "Chapter 21." Introduction. Clinical Laboratory
    Hematology. Boston Pearson, 2010. Print
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