Clinical manifestations, pathologic features, and diagnosis of acute myeloid leukemia
- Charles A Schiffer, MD
Charles A Schiffer, MD
- Professor of Medicine and Oncology
- Barbara Ann Karmanos Cancer Institute
- Wayne State University School of Medicine
- John Anastasi, MD
John Anastasi, MD
- Associate Professor
- University of Chicago
Acute myeloid leukemia (AML, also known as acute myelogenous leukemia) consists of a group of relatively well-defined hematopoietic neoplasms involving precursor cells committed to the myeloid line of cellular development (ie, those giving rise to granulocytic, monocytic, erythroid, or megakaryocytic elements).
AML is characterized by a clonal proliferation of myeloid precursors with a reduced capacity to differentiate into more mature cellular elements. As a result, there is an accumulation of leukemic blasts or immature forms in the bone marrow, peripheral blood, and occasionally in other tissues, with a variable reduction in the production of normal red blood cells, platelets, and mature granulocytes. The increased production of malignant cells, along with a reduction in these mature elements, results in a variety of systemic consequences including anemia, bleeding, and an increased risk of infection. (See "Pathogenesis of acute myeloid leukemia".)
The presenting signs and symptoms and diagnosis of AML will be reviewed in this topic. The subclassification, prognosis, cytogenetics, treatment, and complications of AML and issues related to one of the AML variants, acute promyelocytic leukemia (AML-M3), are discussed separately. (See "Classification of acute myeloid leukemia" and "Prognosis of acute myeloid leukemia" and "Cytogenetics in acute myeloid leukemia" and "Induction therapy for acute myeloid leukemia in younger adults" and "Treatment of acute myeloid leukemia in older adults" and "Overview of the complications of acute myeloid leukemia" and "Clinical manifestations, pathologic features, and diagnosis of acute promyelocytic leukemia in adults".)
AML is the most common acute leukemia in adults and accounts for approximately 80 percent of cases in this group [1,2]. In the United States and Europe, the incidence has been stable at 3 to 5 cases per 100,000 population [3-5]. In contrast, AML accounts for less than 10 percent of acute leukemias in children less than 10 years of age.
In adults, the median age at diagnosis is approximately 65 years. The incidence increases with age with approximately 1.3 and 12.2 cases per 100,000 population for those under or over 65 years, respectively. The male:female ratio is approximately 5:3. This incidence is similar among persons of different races. In one study, non-Hispanic Whites had the highest incidence (4 cases per 100,000 population), while Hispanic Whites, Blacks, and Asian Pacific Islanders had a slightly lower incidence (3 cases per 100,000 population) .
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- CLINICAL PRESENTATION
- Central nervous system
- Myeloid sarcoma
- METABOLIC AND ELECTROLYTE ABNORMALITIES
- PATHOLOGIC FEATURES
- Peripheral blood
- Bone marrow biopsy and aspirate
- - Blast count
- - Cell origin
- - Bone marrow infiltration
- - Cytogenetic features
- - Molecular studies
- DIFFERENTIAL DIAGNOSIS
- WHO CLASSIFICATION
- INFORMATION FOR PATIENTS