Acute Myeloid Leukaemia

Key points

• Acute myeloid leukaemia is the commoner acute leukaemia in adults; it may be primary or follow transformation of a myeloproliferative/myelodysplastic disorder.
• Marrow failure features: anaemia (pallor, lethargy), neutropenia (recurrent infection despite a possibly high total white count), thrombocytopenia (bleeding/bruising), and bone pain.
• Diagnosis: blasts on blood film (Auer rods), and bone marrow with 20% or more blasts; immunophenotyping and cytogenetics/molecular testing define the subtype and risk.
• Treatment: intensive induction (anthracycline + cytarabine) in fit patients to achieve remission, then consolidation +/- allogeneic transplant; targeted agents by genotype (e.g. midostaurin for FLT3-mutated, IDH inhibitors); venetoclax + azacitidine for older/unfit patients.
• Poor prognostic features: increasing age, adverse cytogenetics, high presenting white cell count, and secondary or therapy-related AML.