Leukemia, Acute Myeloid
Basics
Description
- Acute myeloid leukemia (AML) is characterized by proliferation of abnormal immature myeloid progenitors (blasts) with reduced capacity to differentiate leading to bone marrow failure and a variety of systemic symptoms.
- Historically, the French–American–British (FAB) classification system divided AML based on the cell morphology with the addition of cytogenetics (subtypes M0 to M7).
- The World Health Organization (WHO) classifications attempt to provide more meaningful prognostic information.
- AML with defining genetic abnormalities:
- Translocation in t(8;21) RUNX1-RUNX1T1 fusion, t(9;11) KMT2A, t(6;9) DEK-NUP214, t(1;22) RBM15-MRTFA, t(15;17) APL with PML-RARA fusion
- Inversion in chromosome 16 inv(16) CBFB-MYH11, Inv(3) MECOM
- Other defined genetic alterations
- AML, myelodysplasia related: presence of a prior myelodysplastic syndrome (MDS) or myeloproliferative neoplasm (MPN) that transformed into AML
- Myeloid neoplasms post cytotoxic therapy: AML, MDS, and MDS/MPN exposed to cytotoxic therapy
- Myeloid neoplasms associated with germline predisposition: Down syndrome, Fanconi anemia, RASopathies
- Acute leukemias of mixed or ambiguous lineage (biphenotypic acute leukemia)
- Myeloid sarcoma
- AML with defining genetic abnormalities:
Epidemiology
- New cases in men and women is 4.1 per 100,000 per year.
- Male ≥ female
Incidence
The incidence of AML increases with age, and median age is 67 years.
Prevalence
~20,050 cases estimated in 2022, making it the most common type of leukemia in adults
Etiology and Pathophysiology
Genetics
- Three risk groups
- Good risk: inv(16), t(8;21), t(15;17)
- Standard risk: normal karyotype
- Poor risk: monosomy 5 and 7 (typically secondary AML), deletion 5q, abnormalities of 11q23 or complex karyotype
- FLT3 gene mutations, especially internal tandem duplications (FLT3-ITD), have been associated with poor survival in AML. These and growing list of (onco)gene (e.g., NPM1, IDH1/2, DNMT3A, and P53) mutations have been studied to further risk-stratify patients (1).
Risk Factors
- Genetic predisposition (e.g., Down syndrome); Bloom syndrome (~25% develop AML), Fanconi anemia (52%), neurofibromatosis, Li-Fraumeni syndrome, Wiskott-Aldrich syndrome, Kostmann syndrome, and Diamond-Blackfan anemia
- Radiation exposure
- Immunodeficiency states
- Chemical and drug exposure (nitrogen mustard and alkylating agents; benzene)
- MDS
- Cigarette smoking
General Prevention
Treatment of high-risk MDS with hypomethylating agents (5-azacitidine [Vidaza]) may prolong time to transformation from MDS into AML
Commonly Associated Conditions
- Disseminated intravascular coagulopathy (DIC) especially in acute promyelocytic leukemia (APL) but may be seen in any AML
- Leukostasis (high blast number and increased adhesive ability of blasts)
- Tumor lysis syndrome (TLS): spontaneous or in response to chemotherapy
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Citation
Domino, Frank J., et al., editors. "Leukemia, Acute Myeloid." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117516/all/Leukemia__Acute_Myeloid.
Leukemia, Acute Myeloid. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117516/all/Leukemia__Acute_Myeloid. Accessed October 12, 2024.
Leukemia, Acute Myeloid. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117516/all/Leukemia__Acute_Myeloid
Leukemia, Acute Myeloid [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 12]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117516/all/Leukemia__Acute_Myeloid.
* Article titles in AMA citation format should be in sentence-case
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T1 - Leukemia, Acute Myeloid
ID - 117516
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117516/all/Leukemia__Acute_Myeloid
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
ER -