Acute myeloid leukaemia
Authors: Louise Newson, general practitioner, Solihull. Reviewed by Donald Milligan, oncologist, Birmingham. Updated March 2020 by Emma Lackey, general practitioner, Newcastle-upon-Tyne.
Key learning points
- Acute myeloid leukaemia is a malignant disorder characterised by the abnormal proliferation and differentiation of a clonal population of myeloid stem cells.
- The median age at diagnosis is 68.
- Prompt diagnosis and treatment is important.
- Bone marrow failure leads to anaemia, neutropenia (infections) and bleeding; but clinicians need to be aware of the wide range of possible presentations.
- In adults, consider a full blood count (FBC) within 48 hours to assess for leukaemia if any of the following are present: pallor, persistent fatigue, unexplained fever, unexplained persistent or recurrent infection, generalised lymphadenopathy, unexplained bruising, unexplained bleeding, unexplained petechiae or hepatosplenomegaly.
- Children and young people should be referred for immediate specialist assessment for leukaemia if they have unexplained petechiae or hepatosplenomegaly.
- Children and young people should be offered a FBC within 48 hours to assess for leukaemia if any of the following are present: pallor, persistent fatigue, unexplained fever, unexplained persistent infection, generalised lymphadenopathy, persistent or unexplained bone pain, unexplained bruising, unexplained bleeding.
- Medical emergencies can include neutropenic fever/sepsis, hyperleukocytosis, tumour lysis syndrome and disseminated intravascular coagulation.
- Treatments are individualised using prognostic indicators to avoid overtreating patients with favourable prognoses and improve outcomes in those with less favourable prognoses.