Acute myeloid leukemia – clinic

The term “acute myeloid leukemias” (AML) unites a group of acute leukemias arising from the precursor cell of myelopoiesis and differing in certain morphological, immunophenotypic and cytogenetic characteristics. About 10% of AML have an erythroid or megakaryocytic orientation, therefore the term “acute non-lymphoblastic leukemia” (ONLL) is also considered eligible. Thus, AML, or ONLL, is a group of dissimilar leukemias that require different therapeutic approaches.

Acute myeloid leukemia (AML) is diagnosed at any age, but the frequency of its occurrence increases in older age groups. The median age at which AML is diagnosed is 60–65 years, that is, it is a disease of the elderly. On average, AML affects 2 people per 100,000 population per year.

Unlike ALL, myeloid leukemia may be preceded by a pre-leukemic phase (pre-leukemia, myelodysplastic syndrome). Almost 30-40% of elderly patients with the so-called primary (de novo) ONLL detected myelodysplasia.

For acute myeloid leukemias, the connection with radiation, chemical factors (benzene), alkylating agents (mustargen), and epipodophyllotoxins (etoposide) has been proven more clearly than for ALL. The incidence of AML increases when interacting with substances such as totratrast (radiographic contrast agent), pesticides, dyes, rubber, etc.

The clinical manifestations of the disease are very non-specific. Weakness and malaise may precede the diagnosis many months before it is established. Pallor, dizziness can be manifestations of anemic syndrome. Fever and sweating in the debut of the disease are observed in 15-20% of patients, and they may not be associated with any infectious process, which is also often determined at the onset of the disease (tonsillitis, pneumonia, etc.). Frequent symptoms are those or other manifestations of hemorrhagic syndrome.

Petechial rash, ecchymosis is detected at the time of diagnosis in 50% of patients. Sometimes the only symptom of the disease can be bleeding: uterine or nasal, from the gastrointestinal tract, gums, kidneys, etc.

About half of patients complain of a slight weight loss. Ossalgia is noted in 20% of patients. Organomegaly is not a bright diagnostic sign of AML, but an increase in the size of the liver, spleen, lymph nodes is found in 50% of patients. In 10% of patients, specific skin infiltration is defined – leukemides, and most often in acute myeloblastic and monoblastic leukemias. For these same options, a characteristic feature is gum infiltration.

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