ACUTE

MYELOBLASTIC
LEUKAEMIA
DR J.A. OLANIYI
READER/CONSULTANT HAEMATOLOGIST
Stages of Maturation/Differentiation
ALL CLL/LPDs

Lymphoid
Myeloid
AML CML/cMPDs
Acute Myelogenous Leukaemia
(AML)
• Is the result of ----------------.
• It is a neoplastic transformation of ------, ---------,
---------- or ---------.
• This incompetent, long-lived cells suffocate and
dislodge --------; resulting in -----, ------ and --------
• This has been demonstrated through -------, -------,
------ and ------
Myeloid maturation
myelobl promyelocyte
myelocytemetamyelocyte
band neutrophil
ast

MATURATION
Adapted and modified from U Va website
Myelomono
AML
French-American-British (FAB)
Classification

M0: Minimally differentiated leukemia

M1: Myeloblastic leukemia without
maturation
M2: Myeloblastic leukemia with
maturation
M3: Hypergranular promyelocytic
leukemia
M4Eo: Variant: Increase in abnormal
marrow eosinophils
M4: Myelomonocytic leukemia
M5: Monocytic leukemia
Ref-Harrison’s Principle of Internal Medicine
M6: Erythroleukemia (DiGuglielmo's
 Etiology
Unknown / De-novo !! In majority

Predisposing factors:
• I---------
• Previous chemotherapy : -------
• Occupational chemical exposure : -------
• Genetic factors: -----’s Syndrome, -----’s,
-----’s Anemia
• Viral infection ( ------ -1)
• Immunological : --------
• ---------- condition -Secondary
Epidemiology
• ----> -----

• AML predominantly affects ----- and

the ------ unlike ------
• Median age -------yrs

• Geographical variation - -------

Clinical features
General :
Onset is ------ & -------
(usually present within ------ months)

• Bone marrow failure

(-----,
------ ,------)

• Bone ----- & -----

Peculiarities
• M2 : --------- :-presents as a ------- ‘tumor
of ------- cells’

• M3 : ------

• M4/M5 :
• Infiltration of ------
• ------ infiltration,
• ----- deposits ,
• Meningeal involvement: ----------, ------, -----
symptoms
Skin Infiltration with AML (Leukemia -----)
 Diagnosis
• Blood count :

• WBC usually ------ (----,000- -----,000 /

cmm ); may be ---- or ------;
often ----- & -------

• Blood film : (as above)

------ cells
P. Smear AML
• Bone marrow aspirate & trephine:
H---------,
• ------- cells ( > 20%),
• presence of --------- - AML
type

• Cytochemistry :
Special stains to
differentiate AML from ALL ;

Positivity with --------- & ------ in

AML
Jemshidi trephine &
Salah aspiration needle
Auer Rods in Leukemia cells
----- (right) & ------- (left)
showing intense localised
positivity in blasts
• Confirmation:
• I--------
• M---------
• C---------: ----- abnormalities
Other Inv:

• Coagulation screen,
-----------,
D-
--------
• R-------, L-----
• L-----, U------
• U------
• C-----
• ----, E-----
Auer Rod- ------ marker of AML
• Demonstrates that a ------ cell is definitely ----- and
------ in origin
• Shown to be ----------- - a coalescence of -------
containing --------
• demonstrated through ------ and -------- studies.
• Demonstrable by -------- staining in ------% of AML.
Higher with the use of cytochemical detection
technique using ------
Auer rods in AML
Diagnosis
• Established by demonstration of at least ----% -----
in an ---- marrow specimen.
• The cells may be -------, ------ , ------, ------ or ---------
• Marrow cellularity may range from ----- to ------
Classification of AML-Myelogenous

• AML
• M0(3%)Myeloblastic, no -------
• M1(17%) “ -------
• M2(30%) “ ---------
• APL(10%)
• M3 ------- (usual form)
• M3variant{unusual ------ form)
AML M0
AML M1
• AML M1:- ------% or more of blasts stain for ----- or
for --------
• AML M2:- >-----% are ------ and less than ------% are
------ elements

• AML M3:- Abnormal -------, some containing

bundles of ------.
Myelogenous monocytic(AMML)
• M4(25%) A------M-----m--------L-------
• M4Eos with ----------
• M4Baso with -----
AML M3
Monocytic
• Monocytic AMoL
• M5a(4%)A-----M---o----L-----(poorly ------)

• M5b(6%) A-----M---o----L-----(more -----)

AML M4
Gum hypertrophy
Chloromas

C
NEJM 1998
AML M5
Erythroid and Myeloid( M6)
• AEL M6(4%) : A-------E------L--------
• M7(1%) A-----M-------L-----
• Mixed LineageA------ -------- leukaemia
• A) ------ with ------- markers
• B)------- with ----- markers
AML M7
Management
I. Supportive care :
• Anemia – --------
• Thrombocytopenia – ----------
• Infection – ---------------
• Hematopoietic growth factors :
--------, ---------
• --------- nursing
• Indwelling --------
• Complete remission ( CR):
< -----% ------ cells in ------ bone
marrow
• Autologous ----- :
Can be curative in younger
patient (< ----- yrs)
• III. PALLIATIVE THERAPHY
• -----, -----,------
AML Rx
• S--------+:- In terms of leucostsis, haemorrhage ,
sepsis
• P--------
• H----------, A------
• Concentrate support: RBC/ Platelet
Prognosis
• Median survival without treatment is
------ weeks
• -----%; -----yr survival in ----- patients
with ----
• Disease which relapses during
treatment or soon after the end of
treatment has a ----
Poor prognostic factors
• Increasing -----
• ----- sex
• High ------- at diagnosis
• ------ involvement at diagnosis
• ------- abnormalities
• -------- abnormalities (eg. MDS)
• No -----
THANK YOU