Acute Myeloid Leukemia Diagnosis and Treatment

Definition and Epidemiology

The European Society for Medical Oncology defines AML as a clonal hematopoietic malignancy characterized by accumulation of poorly differentiated myeloid cells, defined by ≥20% blasts in peripheral blood or bone marrow 1, 2
The incidence of AML is 5-8 cases per 100,000 individuals annually in European adults, with a steep increase to 15-25 per 100,000 in patients >70 years 1, 3
The mortality rate is 4-6 cases per 100,000 per year 3, 4
The median age at diagnosis is ~70 years, with a higher incidence in males 5

The European Society for Medical Oncology recommends that diagnosis requires examination of both peripheral blood and bone marrow specimens with comprehensive ancillary studies 1, 3
Essential laboratory studies include bone marrow aspirate and biopsy with morphology and cytochemistry, immunophenotyping by flow cytometry, cytogenetics, molecular genetics, routine chemistry, coagulation profile, blood group typing, and HLA typing of patient and family members 3, 4, 6, 7

The European Society for Medical Oncology states that patient age, initial leukocyte count, and co-morbidity are critical prognostic factors, with patients ≥60-65 years having significantly worse outcomes due to treatment complications 3, 6
AML evolved from previously documented MDS carries adverse prognosis 1, 3
Molecular and genetic risk stratification are the key principles guiding AML therapy, with favorable-risk AML including APL with t(15;17)(q22;q12), core binding factor AML, and biallelic CEBPα mutation with normal cytogenetics 3, 4, 7

The European Society for Medical Oncology recommends that AML treatment should be offered in clinical trials whenever possible and administered only in experienced centers with adequate multidisciplinary infrastructure and high case load 6, 7
Treatment should be planned with curative intent whenever feasible, with intensive chemotherapy divided into induction, consolidation, and maintenance phases 2, 4, 6
Potential allogeneic stem cell transplant candidates must be identified early at diagnosis or during induction chemotherapy 6, 7

The European Society for Medical Oncology states that patients >60 years are more susceptible to treatment complications, particularly severe infections, contributing to higher risk of unfavorable outcome 6
Patients with poor performance status, considerable co-morbidity, or elderly patients not eligible for curative treatment should receive supportive care 4, 9
APL must be urgently differentiated from other AML forms by cytomorphology, signs of hyperfibrinolysis, and molecular evidence of PML-RARA fusion, with coagulation status obtained before central line insertion to detect APL-related coagulopathy 5, 6