Medical Importance
The acute leukemias are aggressive malignancies that originate in a
hematopoietic stem cell and are rapidly fatal without immediate
treatment. A significant portion of patients with acute myelogenous
leukemia (AML) can now be cured with chemotherapy. Others can be cured
with stem cell transplantation. As with acute lymphoblastic leukemia,
the successful management of patients with AML requires a therapeutic
strategy determined by careful assessment of individual prognosis,
aggressive supportive therapy, and early recognition and treatment of
complications.
Objectives
- Define “myeloblast” and describe the
consequences of excess myeloblasts in the bone marrow and in the
circulation. Name at least three disease features which result from
replacement of marrow cells with myeloblasts or circulation of
myeloblasts.
- Describe the predominant cell types seen
in the peripheral blood and/or bone marrow in each of the four major
categories of leukemia (AML, ALL, CML, CLL).
- Describe
the unique features of acute promyelocytic leukemia (AML M3), including
the morphologic appearance of the promyelocyte, hemorrhagic
complications, chromosomal abnormality, and treatment with induction
therapy and all trans retinoic acid.
- Name two favorable and two adverse cytogenetic abnormalities in AML.
- Therapy
of AML commonly consists of an induction phase, followed by a
consolidation phase. Be able to describe the principle goals of each
phase of therapy. Be able to state the approximate success rate of
chemotherapy for AML (rate of complete remission with induction
chemotherapy and cure rate).
- Be able to identify the
complications of induction chemotherapy for AML. Name which
complications contribute to mortality.
- Compare and contrast AML and ALL in terms of age of patients, central nervous system involvement, treatment, and outcome.
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