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Acute myelocytic leukemia

Acute myelogenous leukemia (AML), also known as acute myeloid leukemia, is a cancer of the myeloid line of blood cells. The median age of patients with AML is 70; it is rare among children. more...

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Myeloid leukemias are characterized as "acute" or "chronic" based on how quickly they progress if not treated. Chronic myelogenous leukemia (CML) is often without symptoms and can remain dormant for years before transforming into a blast crisis, which is markedly similar to AML.

Pathophysiology

Specific chromosomal abnormalities are seen in patients with some forms of AML. These chromosomal abnormalities tend to disrupt genes that encode for transcription factors needed for myeloid stem cells to differentiate into specific blood components. Without differentiation occurring, these myeloid precursor cells fill the bone marrow and spill out into the blood. The overpopulation of the bone marrow with myeloid precursors also results in supression of normal marrow stem cells, giving rise to the symptoms of anemia (lack of red blood cells), thrombocytopenia (lack of platelets), and neutropenia (lack of neutrophils).

Subtypes

World Health Organization (WHO) classification

The World Health Organization (WHO) classification of acute myeloid leukemia (AML) attempts to be more applicable and produce more meaningful prognostic information then the older French-American-British (FAB) criteria, described below.

The WHO criteria are:

  • AML with characteristic genetic abnormalities, which includes AML with translocations between chromosome 8 and 21 , inversions in chromosome 16 and acute promyelocytic leukemia (APL). Patients with AML in this category generally have a high rate of remission and a better prognosis compared to other types of AML.
  • AML with multilineage dysplasia. This category includes patients who have had prior myelodysplastic syndrome (MDS) or a myeloproliferative diseases (MPD) that transforms into AML. This category of AML occurs primarily in elderly patients
  • AML and MDS, therapy related. This category includes patients who have had prior chemotherapy and/or radiation and subsequently develop AML or MDS.
  • AML not otherwise categorized. Includes subtypes of AML that do not fall into the above categories.
  • Acute leukemias of ambiguous lineage. Acute leukemias of ambiguous lineage (also known as mixed phenotype acute leukemia) occur when the leukemic cells can not be classified as either myeloid or lymphoid cells or where both types of cells are present.

French-American-British (FAB) classification

The older French-American-British (FAB) classification system divided AML into 8 subtypes, M0 through to M7 based on the type of cell from which the leukemia developed and degree of maturity. This is done by examining the appearance of the malignant cells under light microscopy or cytogenetically by characterization of the underlying chromosomal abnormality. Each subtype is characterised by a particular pattern of chromosomal translocations and have varying prognoses and responses to therapy. Although the WHO classification is more useful, the FAB system is still in use.

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Acute childhood leukemia - Columbus, Ohio
From Morbidity and Mortality Weekly Report, 7/25/97

From August-October 1975, 8 cases of acute leukemia were diagnosed at Columbus Children's Hospital in Columbus, Ohio, in children living in that city. During any consecutive 3-month period in 1972-1974, the greatest number of cases of acute leukemia diagnosed at this hospital in Columbus children was 4 (Figure 1).

To evaluate this cluster of illness, all cases of acute leukemia diagnosed at Columbus Children's Hospital in 1972-1975 were reviewed with respect to age, race, sex, type of leukemia, date of diagnosis, and residence in and outside of Columbus (Table 1). The hospital provides care for most children with leukemia in Columbus and for many such patients from surrounding areas. In the 3-year period 1972-1974, an average of 5.3 cases of acute childhood leukemia were seen each year among Columbus residents (the expected number is 6.1, based on age-specific rates from the Third National Cancer Survey [1]). Over the 4-year period 1972-1975, 107 cases were seen, 28 among Columbus residents. Both Columbus and non-Columbus patients in 1975 were somewhat older and included relatively more females than in earlier years. Case distributions by race and leukemia cell type were not unusual.

Twelve cases were diagnosed in Columbus residents in 1975, compared with a total of 16 for all 3 preceding years. To assess the possibility of time-space clustering among Columbus cases over the entire 4-year period a statistical analysis was performed using the procedure devised by Knox (2). No statistically significant clustering was found; 13 case-pairs were observed in which dates of diagnosis were less than 1 year apart and places of residence 1 mile or less apart, whereas 14.4 pairs were to be expected on a random basis. Inspection of the 1975 case data showed no geographic clustering and no obvious community or family interrelationships among cases. No evidence of seasonal periodicity was found on statistical testing by month of diagnosis for pooled data from all 4 years.

Reported by L Ertel, MD, W Newton, MD, Children's Hospital, Columbus, Ohio; TJ Halpin, MD, MPH, State Epidemiologist, Ohio Department of Health; Field Services Div and Cancer and Birth Defects Div Bur of Epidemiology, CDC.

Editorial Note: The question of time-space clustering among cases of leukemia and lymphoma has received considerable epidemiologic attention, particularly in connection with hypotheses regarding the possible viral etiology of cancer. While no evidence has been found of statistically significant time-space clustering among adult cases, several studies have suggested such a tendency among cases of childhood acute leukemia (2-5). The significance of such observations remains unclear. In the present investigation no evidence, statistical or otherwise, was found to suggest that. the recent case cluster in Columbus might be due to factors other than chance. Further investigations of such clusters may be desirable, however, as a potential source of clues regarding the etiology of childhood tumors.

TABLE 1. Acute Leukemia, Columbus Children's Hospital, 1972-1975 -- By Age, Sex, Race, Place of Residence, and Year of Diagnosis

COPYRIGHT 1997 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group

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