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ACUTE MYELOID LEUKEMIA (AML)

AML is a clonal malignancy of myeloid bone marrow precursors in which poorly differentiated cells accumulate in the bone marrow and circulation.

Signs and symptoms occur because of the absence of mature cells normally produced by the bone marrow, including granulocytes (susceptibility to infection) and platelets (susceptibility to bleeding). In addition, if large numbers of immature malignant myeloblasts circulate, they may invade organs and rarely produce dysfunction. There are distinct morphologic subtypes (Table 66-1) that have largely overlapping clinical features. Of note is the propensity of pts with acute promyelocytic leukemia (APL) (FAB M3) to develop bleeding and disseminated intravascular coagulation, especially during induction chemotherapy, because of the release of procoagulants from their cytoplasmic granules.

TABLE 66-1AML Classification Systems

Incidence and Etiology

In the United States about 19,520 cases occurred in 2018. AML accounts for about 80% of acute leukemias in adults. Etiology is unknown for the vast majority. As we age, mutations may occur in normal stem cells that convey a proliferative advantage and establish so-called clonal hematopoiesis. In the setting of clonal hematopoiesis, the relative risk for developing acute leukemia increases but the ...

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