A life-threatening disorder that predominantly occurs in older adults. Many subtypes exist, of which acute promyelocytic leukaemia merits specific management. Characteristically, abnormal blasts are present in the peripheral blood and normal haematopoiesis is reduced. Definitive diagnosis requires bone marrow biopsy. Presence of blast cells in >20% of the bone marrow cells confirms the diagnosis. Cytogenetic abnormalities are prognostically important and affect patient management.
Mortality Between 1950 and 1970 there was a rapid increase in leukaemia mortality, greater in males than females, (Figure 9). Some of this increase may have been due to better diagnosis.Patients with AML typically present with a normocytic, normochromic anemia that can vary in severity. This anemia worsens with induction chemotherapy and is managed primarily with blood transfusions. There is no role for the use of erythropoietic stimulating agents during induction therapy of AML.
Once the diagnosis of acute myeloid leukemia (AML) is established, induction chemotherapy is given with the goal of rapidly restoring normal bone marrow function. Among patients with AML, treatment regimens and outcomes may differ between younger and older adults. Although there is no clear dividing line between younger and older adults when dealing with AML, in most studies, "older adults" has been defined as over age 55 to 60 years. The initial treatment of younger adults with de novo AML will be reviewed here. The following exceptions, which require modification of standard treatment regimens, are discussed separately