Acute promyelocytic leukemia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Sogand Goudarzi, MD; Grammar Reviewer: Natalie Harpenau, B.S.[3]

Overview

The differential diagnosis of acute promyelocytic leukemia includes a variety of other hematologic malignancies, specifically acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL). Each of these conditions has distinct causes and therapies. There is some overlap between the causes and laboratory abnormalities amongst these diseases.

Differentiating Acute promyelocytic meukemia from other Diseases

The following table differentiates acute promyelocytic leukemia from other leukemias that may present with similar clinical features such as fever, fatigue, weight loss, recurrent infections and elevated leukocyte counts. The following are the differentials:

Characteristic Causes Laboratory abnormalities Physical examination Therapy Other associations
Acute myeloid leukemia
  • Variable prognosis based on cytogenetic and molecular profile
  • Five new FDA-approved therapies became available in 2017-2018
Acute promyelocytic leukemia
Acute lymphoblastic leukemia
Chronic myeloid leukemia
Chronic lymphocytic leukemia[6]
  • Elevated absolute lymphocyte count (in all stages)
  • Presence of >5000 clonal B cells per microliter in peripheral blood
  • Anemia (in Rai stage III)
  • Thrombocytopenia (in Rai stage IV)
  • Fludarabine
  • Cyclophosphamide
  • Rituximab
  • Obinutuzumab[7]
  • Ofatumumab
  • Ibrutinib
  • Venetoclax

References

  1. Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Büchner T; et al. (2017). "Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel". Blood. 129 (4): 424–447. doi:10.1182/blood-2016-08-733196. PMC 5291965. PMID 27895058.
  2. McClellan JS, Kohrt HE, Coutre S, Gotlib JR, Majeti R, Alizadeh AA; et al. (2012). "Treatment advances have not improved the early death rate in acute promyelocytic leukemia". Haematologica. 97 (1): 133–6. doi:10.3324/haematol.2011.046490. PMC 3248942. PMID 21993679.
  3. Terwilliger T, Abdul-Hay M (2017). "Acute lymphoblastic leukemia: a comprehensive review and 2017 update". Blood Cancer J. 7 (6): e577. doi:10.1038/bcj.2017.53. PMC 5520400. PMID 28665419.
  4. Inaba H, Greaves M, Mullighan CG (2013). "Acute lymphoblastic leukaemia". Lancet. 381 (9881): 1943–55. doi:10.1016/S0140-6736(12)62187-4. PMC 3816716. PMID 23523389.
  5. Chen Y, Li S (2014). "Omacetaxine mepesuccinate in the treatment of intractable chronic myeloid leukemia". Onco Targets Ther. 7: 177–86. doi:10.2147/OTT.S41786. PMC 3916637. PMID 24516334.
  6. Kipps TJ, Stevenson FK, Wu CJ, Croce CM, Packham G, Wierda WG; et al. (2017). "Chronic lymphocytic leukaemia". Nat Rev Dis Primers. 3: 16096. doi:10.1038/nrdp.2016.96. PMC 5336551. PMID 28102226.
  7. Al-Sawaf O, Fischer K, Engelke A, Pflug N, Hallek M, Goede V (2017). "Obinutuzumab in chronic lymphocytic leukemia: design, development and place in therapy". Drug Des Devel Ther. 11: 295–304. doi:10.2147/DDDT.S104869. PMC 5279834. PMID 28182141.

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