Diagnostic Approach to Acute Myeloid Leukemia

Essential Diagnostic Studies

The American Society of Hematology recommends obtaining a fresh bone marrow aspirate with smear preparation for morphological evaluation, as well as a bone marrow biopsy, to be evaluated jointly with the aspirate 2
The European Society for Medical Oncology suggests that a peripheral blood smear is necessary for morphological evaluation 1, 2
A complete blood count with differential leukocyte count is required for diagnosis 2
Conventional cytogenetic analysis, which cannot be replaced by molecular tests or FISH alone, should be completed before starting any treatment 1, 2

The National Comprehensive Cancer Network states that an age of over 60 years is associated with an adverse prognosis and increased susceptibility to treatment complications 1, 3, 4
A high initial leukocyte count is a factor of adverse risk 1, 3
Pre-existing or concurrent myelodysplastic syndrome is a factor of adverse risk 1
Complex aberrant karyotype is a factor of adverse risk 1

The American College of Medical Genetics recommends that the following chromosomal translocations be considered favorable: t(15;17), t(8;21), and inv(16)/t(16;16) 1, 3

The European Hematology Association suggests that coagulation tests should be performed before insertion of central venous catheters 1, 3
Echocardiography is recommended for patients with risk factors or a history of heart disease 1, 3
Complete hematological and chemical tests should be performed 1, 3

The American Society of Clinical Oncology recommends that chemotherapy should be postponed until satisfactory material has been obtained for all diagnostic tests 1, 3, 2
Patients with excessive leukocytosis at presentation may require emergency leukapheresis before induction chemotherapy 1, 3

The College of American Pathologists states that all laboratory tests must be performed in laboratories that meet regulatory requirements 2
Ideally, the same physician should interpret both bone marrow aspirate smears and core biopsy samples 2
Treatment should be planned in centers that offer a multidisciplinary approach with a full hematology and medical oncology service, close collaboration with a bone marrow transplant unit, an infectious disease unit, and an adequate transfusion service 1, 3