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Acute myeloid leukaemia 

Acute myeloid leukaemia
Chapter:
Acute myeloid leukaemia
Author(s):

Nigel Russell

, and Alan Burnett

DOI:
10.1093/med/9780198746690.003.0515
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date: 07 March 2021

Acute myeloblastic leukaemia arises in a haematopoietic stem cell as a result of mutations which promote growth or inhibit apoptosis in association with mutations that inhibit differentiation. There is usually no obvious cause, but exposure to chemical and ionizing radiation may be relevant, including previous chemotherapy for solid tumours. This leukaemia arises particularly in older patients, often in the context of antecedent haematological disorders such as myelodysplastic syndromes or myeloproliferative neoplasms. Clinical features are of marrow failure, with anaemia, bleeding (petechiae, purpura, from mucous membranes), and infection. Acute promyelocytic leukaemia should be viewed as a medical emergency characterized by disseminated intravascular coagulation which requires urgent treatment to avoid haemorrhagic death. Aside from providing appropriate supportive care, the first clinical decision to be made is whether to give conventional intensive chemotherapy aiming for disease eradication, or to adopt a more palliative approach. Intensive chemotherapy is the norm up to age 65 to 70 years. Above this age, the biology of the disease tends to be less favourable and patients may have significant comorbidities limiting treatment tolerance. In patients under 60 years, 75 to 80% will achieve initial remission and about 45 to 50% will survive. In older patients given intensive treatment, 50 to 60% will enter remission but only 15 to 20% will survive 2 years. With nonintensive treatments, remissions are seen in 15 to 25% with the median survival being 6 to 9 months. Relapsed disease—more than 50% of patients will ultimately relapse and their overall outcome is generally very poor. The best curative option is allogeneic stem cell transplantation if a second complete remission can be achieved with reinduction chemotherapy.

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