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Acute Myeloid Leukemia (AML)

Genomically complex myeloid malignancy with targeted and intensive chemotherapy approaches

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Hematoloji department. Book Appointment →

What is Acute Myeloid Leukemia (AML)?

Acute myeloid leukemia (AML) is a clonal malignancy of hematopoietic myeloid precursors resulting in bone marrow failure. Median age at diagnosis is 68 years. ELN 2022 and WHO 5th edition classifications integrate cytogenetics, molecular markers, and morphology for prognosis.

Risk stratification uses cytogenetics (t(8;21), inv(16), t(15;17) — acute promyelocytic leukemia; complex karyotype, monosomal karyotype) and mutations (FLT3-ITD, FLT3-TKD, NPM1, CEBPA, TP53, ASXL1, RUNX1, IDH1, IDH2).

Diagnosis requires ≥20% blasts in marrow or blood (or certain recurrent cytogenetic abnormalities regardless of blast count), immunophenotyping, cytogenetics, FISH, and targeted sequencing for actionable mutations at diagnosis.

Acute promyelocytic leukemia (APL) with t(15;17) PML-RARA is a curable subtype treated with all-trans retinoic acid (ATRA) and arsenic trioxide. Other AML subtypes require intensive induction or lower-intensity regimens based on fitness and biology.

Symptoms

Fatigue, pallor, dyspnea from anemia
Fever, infection from neutropenia
Bleeding, bruising, petechiae, gingival hemorrhage from thrombocytopenia
Gum hypertrophy, skin infiltration (chloroma) in monocytic subtypes
Bone pain, splenomegaly (variable)
Disseminated intravascular coagulation, particularly in APL — a bleeding emergency

Risk Factors

Advanced age
Prior chemotherapy (alkylating agents, topoisomerase II inhibitors) — therapy-related AML
Prior radiation exposure, benzene, and other environmental toxins
Preceding myelodysplastic syndrome, myeloproliferative neoplasm, or aplastic anemia
Inherited syndromes: Down syndrome, Fanconi anemia, Li-Fraumeni, germline RUNX1, CEBPA, DDX41
Smoking, obesity, and certain viral exposures

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Unexplained cytopenias, persistent fatigue with fever or bleeding, or circulating blasts on blood smear require immediate hematology-oncology evaluation and marrow examination.
  • Suspected acute promyelocytic leukemia (pancytopenia, DIC, coagulopathy) is a true emergency — start ATRA and transfusion support immediately while awaiting confirmatory testing.
  • Leukostasis symptoms (dyspnea, altered mental status, hyperleukocytosis) require urgent leukapheresis, hydroxyurea, and induction chemotherapy.

Treatment Methods

01
APL: ATRA plus arsenic trioxide (low-intermediate risk) or ATRA-arsenic-chemotherapy (high risk); supportive care for coagulopathy with aggressive platelet and cryoprecipitate transfusion.
02
Fit patients with non-APL AML: intensive induction with '7+3' (cytarabine and daunorubicin or idarubicin); addition of midostaurin for FLT3-mutated or gemtuzumab ozogamicin for CD33-positive favorable-risk.
03
Unfit or older patients: venetoclax combined with azacitidine or decitabine (VIALE-A); lower-intensity regimens; IDH1 (ivosidenib), IDH2 (enasidenib), FLT3 inhibitors based on mutation.
04
Consolidation: high-dose cytarabine for favorable-risk cytogenetics; allogeneic hematopoietic stem cell transplant for intermediate- and adverse-risk AML in fit patients with suitable donors.
05
Relapsed/refractory AML: enrollment in clinical trials, alternative induction, targeted agents by mutation (gilteritinib for FLT3, IDH inhibitors), transplant.
06
Supportive care: transfusion support, infection prophylaxis, growth factors, central line care, fertility preservation discussion, survivorship follow-up.

Which Department to Visit?

You can visit our Hematoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.