Description Type Freq Description

No differentiation M4 20% Myelomonocytic

(maturation) M4Eo Eo = eosinophilic var.

Myeloblast« w min. diff. M5 20% Monoblast«

Myeloblast« w diff. M6 5% Erythroleukemia

Promyelocytic (APML) M7 <5% Megakaryobtastic WHO Classification of AML

Subtype

Examples

With recurrent genetic abnormalities

t(8;21); inv(16): t(15;17); 11q23 anomalies

With multilineage dysplasia

With or without antecedent MDS or MPD

Therapy-related

Not otherwise categorized

Alkylating agents or topoisomerase inhibitors Other entities as defined in FAB system

Type

Freq

M0

<5%

M1

20%

M2

25%

M3

• Induction chemo (non-M3):"3 + 7" - Ida daunorubicin x 3 d • cytarabine • 7 d

• ✓ for complete remission (CR) normal peripheral counts. 5% BM blasts

CR / cure must always f u induction with consolidation Rx

• If © CR: consolidation Rx based on risk stratification: chemotherapy or allogeneic or autologous HSCT (NE/M 1995:331217; Lancet 1998.3S1 700.N£;M 1998:339.1649)

• If © CR: reinduction with similar chemotherapy

• If relapse after CR: salvage chemotherapy followed by allogeneic or autologous HSCT

• M3 subtype = APML: defined by t( 15:17) translocation ( 95% of cases), biologically distinct; responds to all-trons-retinoic acid (ATRA). which induces differentiation; induction chemotherapy is anthracycline • ATRA • cytarabine; both untreated and refractory M3 AML also respond to arsenic trioxide; consolidation Rx is followed by prolonged maintenance Rx

• Supportive care: hydration * allopurinol or raspuricase for tumor lysis prophylaxis:

transfusions • erythropoietin and G-CSF; antibiotics for fever and neutropenia; hydroxyurea : leukophoresis for leukostasis Prognosis

• CR achieved in 70-80% of Pts - 60 y and in 40-50% for Pts -60 y

• Overall survival depends on prognostic factors: ranges from 50% for Pts 60 y w o poor prognostic factors to 10% for Pts 60 y w poor prognostic factors

• Poor prognostic factors: age >60. unfavorable cytogenetics (eg. monosomy or del. of chr. 5 or 7. complex karyotype), poor performance score, antecedent MDS MPD

• Gene expression profiling may be useful <nejm 2004:3301605.1617.8/ood 2007:109431)

• APML is the most favorable subtype b c of response to ATRA (70-80% cure rate)

Was this article helpful?

0 0

Post a comment