Acute myeloid leukaemia
Description
- Clonal expansion of myeloid blasts with differentiation block + marrow failure
- >=20% blasts in blood or marrow
- *Except AML with a defining genetic abnormality - t(8;21), inv(16)/t(16;16), PML::RARA, NPM1, KMT2A-r, NUP98-r and others are AML at any blast count* (WHO 5th ed; ICC uses a >=10% floor)
- Only AML with BCR::ABL1 and AML with CEBPA mutation still require >=20%
- Myeloid sarcoma (chloroma) is AML wherever it appears - tissue diagnosis alone is sufficient
Categories that change management
- APML (t(15;17), PML::RARA) - a medical emergency and a chemotherapy-free cure
- AML with myelodysplasia-related changes / secondary AML - worse, and treated differently
- Therapy-related AML
- Germline predisposition - RUNX1, CEBPA, DDX41, GATA2, ANKRD26, ETV6, Fanconi
- Matters before using a family member as a stem cell donor
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