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! style="padding: 0 5px; font-size: 80%; background: #A8A8A8;" align="center" |{{fontcolor|#2B3B44|Acute leukemia<BR>Resident Survival Guide}}
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align="left" |[[{{PAGENAME}}#Overview|Overview]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align="left" |[[{{PAGENAME}}#Causes|Causes]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align="left" |[[{{PAGENAME}}#FIRE: Focused Initial Rapid Evaluation|FIRE]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align="left" |[[{{PAGENAME}}#Complete Diagnostic Approach|Diagnosis]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align="left" |[[{{PAGENAME}}#Treatment|Treatment]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align="left" |[[{{PAGENAME}}#Do's|Do's]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC; border-radius: 5px 5px 5px 5px;" align="left" |[[{{PAGENAME}}#Don'ts|Don'ts]]
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__NOTOC__
__NOTOC__
{{Resident survival guide project}}


{{WikiDoc CMG}}; {{AE}} {{ABehjat}}
{{CMG}}; {{AE}} {{ABehjat}}
 
{{SK}} Acute lymphocytic leukemia, Acute myeloid leukemia, ALL, AML
==Overview==
==Overview==
Polycythemia is defined as increasing the hemoglobin (>16.5 g/dl in men or >16 g/dl in women) or hematocrit level (>49%in men or >48% in women).<ref name="pmid29426921">{{cite journal| author=Barbui T, Thiele J, Gisslinger H, Kvasnicka HM, Vannucchi AM, Guglielmelli P | display-authors=etal| title=The 2016 WHO classification and diagnostic criteria for myeloproliferative neoplasms: document summary and in-depth discussion. | journal=Blood Cancer J | year= 2018 | volume= 8 | issue= 2 | pages= 15 | pmid=29426921 | doi=10.1038/s41408-018-0054-y | pmc=5807384 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29426921  }}</ref> This elevated level might be due to declining the plasma volume (relative or spurious polycythemia) or rising the number of red blood cells (true polycythemia). <ref name="pmid30252337">{{cite journal |vauthors=Pillai AA, Fazal S, Babiker HM |title= |journal= |volume= |issue= |pages= |date= |pmid=30252337 |doi= |url=}}</ref>
Acute Leukemia is a malignancy of bone marrow myeloid and lymphoblastic precursor cells, in which these poorly differentiated hematopoietic cells proliferate rapidly. Hence, their accumulation would disrupt the performance of bone marrow to produce normal blood cells
<div align="center"><gallery heights="200" widths="200">
Image:AML_(2).png
Image:ALL2.png
</gallery>
</div>


==Causes==
==Causes==
===Life Threatening Causes===
AML and ALL are life-threatening diseases, which would result in death if left untreated. In the majority of cases, etiology is not apparent.
 
===Common Causes of AML===  
 
*[[Gene mutations:FLT3, IDHI, IDH2, KRAS, DNMT3A, NPM1]]
*[[Chromosomal translocations, deletions, and inversions]]
*[[ Benzene or radiation exposure chronically]]<ref name="pmid23634996">{{cite journal| author=Cancer Genome Atlas Research Network. Ley TJ, Miller C, Ding L, Raphael BJ, Mungall AJ | display-authors=etal| title=Genomic and epigenomic landscapes of adult de novo acute myeloid leukemia. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 22 | pages= 2059-74 | pmid=23634996 | doi=10.1056/NEJMoa1301689 | pmc=3767041 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23634996  }} </ref> <ref name="pmid8361504">{{cite journal| author=Thirman MJ, Gill HJ, Burnett RC, Mbangkollo D, McCabe NR, Kobayashi H | display-authors=etal| title=Rearrangement of the MLL gene in acute lymphoblastic and acute myeloid leukemias with 11q23 chromosomal translocations. | journal=N Engl J Med | year= 1993 | volume= 329 | issue= 13 | pages= 909-14 | pmid=8361504 | doi=10.1056/NEJM199309233291302 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8361504  }} </ref>
 
 
===Common Causes of ALL===
*[[Radiation exposure]]
*[[Genetic disorders; e.g., Down syndrome, ataxia-telangiectasia, Fanconi anemia]]
*[[Certain infections: e.g., HTLV-1]] <ref name="pmid23523389">{{cite journal| author=Inaba H, Greaves M, Mullighan CG| title=Acute lymphoblastic leukaemia. | journal=Lancet | year= 2013 | volume= 381 | issue= 9881 | pages= 1943-55 | pmid=23523389 | doi=10.1016/S0140-6736(12)62187-4 | pmc=3816716 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23523389  }} </ref>
 
==FIRE==
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.
 
*Focused Initial Rapid Evaluation (FIRE) in AML <ref name="TallmanWang2019">{{cite journal|last1=Tallman|first1=Martin S.|last2=Wang|first2=Eunice S.|last3=Altman|first3=Jessica K.|last4=Appelbaum|first4=Frederick R.|last5=Bhatt|first5=Vijaya Raj|last6=Bixby|first6=Dale|last7=Coutre|first7=Steven E.|last8=De Lima|first8=Marcos|last9=Fathi|first9=Amir T.|last10=Fiorella|first10=Melanie|last11=Foran|first11=James M.|last12=Hall|first12=Aric C.|last13=Jacoby|first13=Meagan|last14=Lancet|first14=Jeffrey|last15=LeBlanc|first15=Thomas W.|last16=Mannis|first16=Gabriel|last17=Marcucci|first17=Guido|last18=Martin|first18=Michael G.|last19=Mims|first19=Alice|last20=O’Donnell|first20=Margaret R.|last21=Olin|first21=Rebecca|last22=Peker|first22=Deniz|last23=Perl|first23=Alexander|last24=Pollyea|first24=Daniel A.|last25=Pratz|first25=Keith|last26=Prebet|first26=Thomas|last27=Ravandi|first27=Farhad|last28=Shami|first28=Paul J.|last29=Stone|first29=Richard M.|last30=Strickland|first30=Stephen A.|last31=Wieduwilt|first31=Matthew|last32=Gregory|first32=Kristina M.|last33=Hammond|first33=Lydia|last34=Ogba|first34=Ndiya|title=Acute Myeloid Leukemia, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology|journal=Journal of the National Comprehensive Cancer Network|volume=17|issue=6|year=2019|pages=721–749|issn=1540-1405|doi=10.6004/jnccn.2019.0028}}</ref><ref>{{cite book | last = Jameson | first = J | title = Harrison's principles of internal medicine | publisher = McGraw-Hill Education | location = New York | year = 2018 | isbn = 978-1259643996 }}</ref>:
 
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Obtain patient's medical history and focus on these signs and symptoms:''' <br> ❑ [[Fatigue]] <br> ❑ [[Weight loss]] <br> ❑ [[Anorexia]] <br> ❑ [[Bone pain]] <br> ❑ [[Bleeding]]  <br> ❑ [[Early satiety]] <br> ❑ History of specific and chronic exposures such as alkylating agents, benzene, radiation, or previous chemotherapy <br> ❑ [[Headache]] <br> ❑ [[History of recurrent fever]]</div>}}
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | F01 | | | | | | | | | | | | | | |F01=<div style="float: left; text-align: left; line-height: 150% ">'''Examine the patient:''' <br> ❑ [[Fever]] <br>  ❑ [[Ecchymosis]] <br>  ❑ [[Lymphadenopathy]] <br>❑ [[Splenomegaly]] <br> ❑ [[Hepatomegaly]]<br> ❑ Mediastinal mass  <br>❑ Abnormalities in cranial nerve examination <br> ❑ [[Skin Petechiae]]<br> ❑ Testicular enlargement < <br>  </div> }}
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
 
{{Family tree | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; line-height: 150% ">'''Hematologic evaluation:'''<br>
❑ [[CBD including platelets and WBCs)]] <br> ❑ [[Uric acid]], [[BUN]], [[Cr]], [[Liver function test]]s, [[bilirubin]],[[Ca]], [[P]], [[Sodium]], [[potassium]], <br> ❑ [[amylase]], and [[lipase]] <br> ❑ [[Lactate dehydrogenase]] <br> ❑ [[PT]], [[PTT]] <br> ❑ [[D-dimer]], [[fibrinogen]] <br>  ❑ [[Viral antibodies]], [[(varicella-zoster]], [[CMV]]), [[HSV-1]] ❑ Peripheral blood smear</div>}}
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
 
{{Family tree | | | | | | | | | | | | | | B02 | | | | | | | | | | | | | | | B02= <div style="float: left; text-align: left; line-height: 150% ">'''Radiologic assessment:''' <br> ❑ '''[[CXR]] (PA and lateral)  <br> ❑ [[PET]] or [[CT scan]] (if [[extramedullary disease]] is doubted based on symptoms and physical exam)  <br>  ❑  [[CT]], or [[MRI]], and other  imaging methods to diagnose [[ICH]], [[brain]] or [[spinal cord tumor]]s, and [[leptomeningeal disease]] (if patient presenting notable CNS signs and symptoms <br> </div>}}
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | E01 | | | | | | | | | | | | | | |E01=<div style="float: left; text-align: left; line-height: 150% ">''' ❑ [[Bone marrow aspiration]] and biopsy <br> </div>}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree/end}}
 
*Focused Initial Rapid Evaluation (FIRE) in ALL:<ref name="pmid23523389">{{cite journal| author=Inaba H, Greaves M, Mullighan CG| title=Acute lymphoblastic leukaemia. | journal=Lancet | year= 2013 | volume= 381 | issue= 9881 | pages= 1943-55 | pmid=23523389 | doi=10.1016/S0140-6736(12)62187-4 | pmc=3816716 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23523389  }} </ref> <ref name="pmid31910389">{{cite journal| author=Brown P, Inaba H, Annesley C, Beck J, Colace S, Dallas M | display-authors=etal| title=Pediatric Acute Lymphoblastic Leukemia, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. | journal=J Natl Compr Canc Netw | year= 2020 | volume= 18 | issue= 1 | pages= 81-112 | pmid=31910389 | doi=10.6004/jnccn.2020.0001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31910389  }} </ref> <ref name="pmid25060251">{{cite journal| author=Rose-Inman H, Kuehl D| title=Acute leukemia. | journal=Emerg Med Clin North Am | year= 2014 | volume= 32 | issue= 3 | pages= 579-96 | pmid=25060251 | doi=10.1016/j.emc.2014.04.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25060251  }} </ref>
 
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Take a precise medical history and focus on these signs and symptoms:''' <br> ❑ [[Fatigue]] <br>  ❑ [[Anorexia]] <br> ❑ [[Bone and joint pain]] <br> ❑ [[Bleeding]]  <br> ❑ [[Weakness and lethargy]] <br> ❑ History of  prior exposures with alkylating agents, radiation, or previous chemotherapy (less prevalent than AML) <br> ❑ [[Headache]] <br> ❑ [[History of bleeding or unexplained bruising]] <br> ❑ History of congenital syndroms <br> ❑ [[Night sweats, weight loss and fever(B symptoms)]] <br>❑ [[Abdominal distention]] <br></div>}}
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
{{Family tree | | | | | | | | | | | | | | F01 | | | | | | | | | | | | | | |F01=<div style="float: left; text-align: left; line-height: 150% ">'''Examine the patient:''' <br> ❑ [[Fever]] <br> ❑ [[Tachycardia]]<br>  ❑ Mediastinal mass <br>  ❑ [[Lymphadenopathy]] <br>❑ [[Splenomegaly]] <br> ❑ [[Hepatomegaly]]<br> ❑ Abnormalities in cranial nerve examination <br> ❑ [[Skin Petechiae]] <br> ❑Testicular enlargement (rare) <br> </div> }}
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}


* Critical dehydration owing to fluid loss such as severe diarrhea or vomiting, which can result in Spurious Polycythemia
{{Family tree | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | |B01=<div style="float: left; text-align: left; line-height: 150% ">'''Hematologic evaluation:'''<br>
* Severe cyanotic heart diseases with right-to-left shunts
❑ [[CBD including platelets and WBCs)]] <br> ❑ [[Uric acid]], [[BUN]], [[Cr]], [[Liver function test]]s, [[bilirubin]] <br> ❑ [[Lactate dehydrogenase]] , potassium, phosphates, and calcium <br> ❑ d-dimer, fibrinogen, PT, and PTT <br> ❑ Peripheral blood smear <br> </div>}}
* End-stage cancer related to EPO-secreting tumors such as hepatocellular carcinoma, parathyroid carcinoma, pheochromocytoma, or renal cell carcinoma<ref name="McMullinBareford2005">{{cite journal|last1=McMullin|first1=Mary F.|last2=Bareford|first2=D.|last3=Campbell|first3=P.|last4=Green|first4=A. R.|last5=Harrison|first5=Claire|last6=Hunt|first6=Beverley|last7=Oscier|first7=D.|last8=Polkey|first8=M. I.|last9=Reilly|first9=J. T.|last10=Rosenthal|first10=E.|last11=Ryan|first11=Kate|last12=Pearson|first12=T. C.|last13=Wilkins|first13=Bridget|title=Guidelines for the diagnosis, investigation and management of polycythaemia/erythrocytosis|journal=British Journal of Haematology|volume=130|issue=2|year=2005|pages=174–195|issn=0007-1048|doi=10.1111/j.1365-2141.2005.05535.x}}</ref>
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}


===Common Causes===
{{Family tree | | | | | | | | | | | | | | B02 | | | | | | | | | | | | | | | B02= <div style="float: left; text-align: left; line-height: 150% ">'''Radiologic assessment:''' <br> ❑ '''[[CXR]] (PA and lateral) to rule out mediastinal masses  <br>  ❑  Brain CT scan and MRI  with contrast if neurologic signs and symptoms have existed <br> ❑ Scrotal ultrasound for assessing testicular involvement <br> ❑ Echocardiogram or cardiac scan <br>  A whole body PET or CT scan when lymphoblastic lymphoma is doubted </div>}}
:Primary polycythemia
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
:* [[Polycythemia vera]] and its complications
{{Family tree | | | | | | | | | | | | | | E01 | | | | | | | | | | | | | | |E01=<div style="float: left; text-align: left; line-height: 150% ">''' ❑ [[Bone marrow aspiration]] and biopsy <br> </div>}}
:Secondary polycythemia
{{Family tree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
:* [[Chronic lung disease]]
{{Family tree | | | | | | | | | | | | | | E01 | | | | | | | | | | | | | | |E01=<div style="float: left; text-align: left; line-height: 150% ">''' ❑ [[Lumbar puncture]] <br> </div>}}
:* [[High altitude]]
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
:* EPO-producing tumors
{{familytree/end}}
:* High carboxyhemoglobin: mostly observed in smokers
:*Kidney diseases, such as Renal cysts and renal artery stenosis,
:* Iatrogenic reasons: steroids, erythropoietin treatment, anabolic testosterone replacement therapy. This elevated level might be due to declining the plasma volume (relative or spurious polycythemia) or rising the number of red blood cells (true polycythemia). <ref name="pmid30252337">{{cite journal |vauthors=Pillai AA, Fazal S, Babiker HM |title= |journal= |volume= |issue= |pages= |date= |pmid=30252337 |doi= |url=}}</ref>


==Diagnosis==
==Diagnosis==
Shown below is an algorithm summarizing the diagnosis of [[polycythemia]] according the hematology guidelines. <ref name="pmid30252337">{{cite journal |vauthors=Pillai AA, Fazal S, Babiker HM |title= |journal= |volume= |issue= |pages= |date= |pmid=30252337 |doi= |url=}}</ref> <ref name="McMullinBareford2005">{{cite journal|last1=McMullin|first1=Mary F.|last2=Bareford|first2=D.|last3=Campbell|first3=P.|last4=Green|first4=A. R.|last5=Harrison|first5=Claire|last6=Hunt|first6=Beverley|last7=Oscier|first7=D.|last8=Polkey|first8=M. I.|last9=Reilly|first9=J. T.|last10=Rosenthal|first10=E.|last11=Ryan|first11=Kate|last12=Pearson|first12=T. C.|last13=Wilkins|first13=Bridget|title=Guidelines for the diagnosis, investigation and management of polycythaemia/erythrocytosis|journal=British Journal of Haematology|volume=130|issue=2|year=2005|pages=174–195|issn=0007-1048|doi=10.1111/j.1365-2141.2005.05535.x}}</ref> <ref>{{cite book | last = Jameson | first = J | title = Harrison's principles of internal medicine | publisher = McGraw-Hill Education | location = New York | year = 2018 | isbn = 978-1259643996 }}</ref>
Diagnostic criteria of acute myeloid leukemia and acute lymphoblastic leukemia are similar to one another.
*According to the 2016 WHO criteria observing ≥20% blasts in the bone marrow biopsy or peripheral blood smear is diagnostic for AML. These genetic abnormalities in AML are diagnostic even with less than 20% marrow blasts: inv(16), t(16;16), t(8;21), and t(15;17).<ref name="pmid10643532">{{cite journal| author=Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J | display-authors=etal| title=The World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. Report of the Clinical Advisory Committee meeting, Airlie House, Virginia, November, 1997. | journal=Ann Oncol | year= 1999 | volume= 10 | issue= 12 | pages= 1419-32 | pmid=10643532 | doi=10.1023/a:1008375931236 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10643532  }} </ref>


{{Family tree/start}}
*Presenting ≥20% of leukemic lymphoblasts in bone marrow aspirate and biopsy would prove ALL.<ref name="pmid25408859">{{cite journal| author=Chiaretti S, Zini G, Bassan R| title=Diagnosis and subclassification of acute lymphoblastic leukemia. | journal=Mediterr J Hematol Infect Dis | year= 2014 | volume= 6 | issue= 1 | pages= e2014073 | pmid=25408859 | doi=10.4084/MJHID.2014.073 | pmc=4235437 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25408859 }} </ref>
{{Family tree | | | | A01 | | | |A01= Elevated Hgb or Hct}}
 
{{Family tree | | | | |!| | | | | }}
==Treatment==  
{{Family tree | | | | A01 |-|-|-| A02 |-|-|-| A03 | |A01= Assess RBC mass| A02= if normal| |A03= Relative erythrocytosis}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | A01 | | | |A01= If High level}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | B01 |-|-|-| B02 |-|-|-| B03 |-|-|-| B04 | |B01= Measure EPO level| B02= If Low| |B03= Polycythemia vera| |B04= Check JAK2 mutation to confirm}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | B01 | | | |B01= If High level}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | B01|-|-|-| A02 |-|-|-| A03 | |B01= Assess arterial O2 saturation| A02= If low| |A03= Assess cardiac or pulmunary diseases, such as right to left shunts, COPD, high altitute}} | | | |}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | A01 | | | |A01= If normal}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | B01|-|-|-| A02 |-|-|-| A03|-|-|-| A04|-|-|-| A05 | |B01= Is the paitient smoker?| A02= If no| |A03Measure Hgb O2 affinity| A04=If normal| A05=Diagnostic evaluation for finding tumor producing EPO: Kidney sonography, Brain CT, Abdominopelvic Ct scan}} | | | |}}
{{Family tree | | | | |!| | | | | | | | | | |!|!|}}
{{Family tree | | | | |!| | | | | | | | | | |!|C01 |-|-| C02 | |C01=If incresed|C02=High oxigen affinity hemoglobinopathy| | | |}}
{{Family tree | | | | A01 | | | | | | | | | |!| |A01= If yes}}
{{Family tree | | | | |!| | | | | | | | | | |!| |}}
{{Family tree | | | | |!| | | | | | | | | | |!| |}}
{{Family tree | | | | |!| | | | | | | | | | |!| |}}
{{Family tree | | | | A01 |-|-|-|-|-|-|-|A02| |A01= Evaluate carboxihemoglobin levels|A02= If normal}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | A01 | | | |A01= If High}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | A01 | | | |A01= Smoker's polycythemia}}
{{Family tree/end}}


==Treatment==
{{familytree/start |summary=Sample 6}}
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
{{familytree | | | | | | | | | | | | | | | | | | A01 |A01= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Treatment of a patient with definitive AML'''<ref name="pmid26376137">{{cite journal| author=Döhner H, Weisdorf DJ, Bloomfield CD| title=Acute Myeloid Leukemia. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 12 | pages= 1136-52 | pmid=26376137 | doi=10.1056/NEJMra1406184 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26376137  }} </ref> <ref name="pmid27895058">{{cite journal| author=Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Büchner T | display-authors=etal| title=Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. | journal=Blood | year= 2017 | volume= 129 | issue= 4 | pages= 424-447 | pmid=27895058 | doi=10.1182/blood-2016-08-733196 | pmc=5291965 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27895058  }} </ref> <ref>{{cite book | last = Jameson | first = J | title = Harrison's principles of internal medicine | publisher = McGraw-Hill Education | location = New York | year = 2018 | isbn = 978-1259643996 }}</ref>
{{familytree/start}}<nowiki>{{familytree | | | | | | | | | A01 | | | | | |A01=The main treatment in polycythemia Vera }}
</div>}}  
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|.| | | }}
{{familytree | | | | | | | | | B01 | | | | | |B01=Phlebotomy in order to keep hematocrit lower than 45% and prescribe Aspirin(40-100 mg) once every day }}
{{familytree | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | | | | | | | B02 | |B01=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''Treating for the first time(new case)''' </div>|B02= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Cases with relapsed/refractory AML''' </div>}}
{{familytree | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }}
{{familytree | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | | | | | | | | |!| | }}
{{familytree | | C01 | | | | | | | | | | | |C02|C01=Low-risk patient (without any history of thrombosis and ≤60 years)|C02= High-risk patient (with a history of thrombosis or older than 60 years )}}
{{familytree | C01 | | | | | | C02 | | | | | | | | | C03 | | | | | | | | | | | | | | | | C04 |C01= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Favorable-Risk Cytogenetics''' </div>|C02= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Intermediate-Risk Cytogenetics''' </div>
{{familytree | | |!| | | | | | | | | | | | | |!| }}
|C03= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Poor-Risk Cytogenetics|C04= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Salvage therapy''' </div>}}
{{familytree | | D01 | | | | | | | | | | | |D02|D01=If a patient has microvascular symptoms, which have not been controlled sufficiently  or  leukocytosis  or cardiovascular symptoms specifically hypertension|D02=Add hydroxyurea with the initial dose of 500 mg twice daily}}
{{familytree | |!| | | | | | | |!| | | | | | | | | | |!| | | | |!| | | | | | | | | | | | |!| | }}
{{familytree | | |!| | | | | | | | | |,|-|-|-|^|-|-|-|.|}}
{{familytree | D01 | | | | | | D02 | | | | | | | | | D03 | | | | | | | | | | | | | | | | D04 | |D01= Select one of these therapies: <br> ❑ 1. Induction treatment: Cytarabine-based regimen + Daunorubicin. If a complete remission is achieved, postremission consolidation therapy as maintenance should be started: intermediate  dose of Cytarabine) <br> ❑ 2.Investigational drugs(clinical trial): for cases aged younger than 60 years, a standard chemotherapy regimen including a backbone of Cytarabine + Anthracycline has been recommended. After complete remission, postremission therapy have to be regarded.
{{familytree | | E01 | | | | | | | | E02 | | | | | |E04|E01=Prescribe Aspirin BID|E02=If the patient has a history of arterial thrombosis|E03=E03|E04=If the patient has a history of venous trombosis}}
|D02=Select one of these treatments: <br>
{{familytree | | | | | | | | | | | | |!| | | | | | | |!| | }}
❑ 1. Investigational therapy: for patients older than 65 or have more comorbidities and high-risk illnesses or cases who cannot tolerate Cytarabine-based regimen + Daunorubicin, changing their regiments to an investigational therapy could be regarded. (administrate one chemotherapy drug or combine their treatment with non-intensive medications fitting with the patient such as decitabine, azacitidine). After complete remission, postremission therapy have to be regarded.<br> ❑ 2. Induction treatment: Cytarabine-based regimen + Daunorubicin (could be suitable for young and elderly patients). If complete remission(CR) is achieved, postremission consolidation therapy as maintenance should be started to prevent relapse, including: <br>
{{familytree | | | | | | | | | | | | F01 | | | | | | F03 |F01=Prescribe Aspirin BID|F02=F02|F03=Add systemic anticoagulant therapy}}
:*  Allogenic hematopoietic cell transplantation, which is the preferred treatment, or <br>
:*  If the patient is younger than 60 years autologous hematopoietic cell  transplantation is recommended, or <br> 
:*  Intermediate  dose of Cytarabine
||D03= Select one of these therapies:<br> 1. Induction treatment: Cytarabine-based regimen + Daunorubicin (could be suitable for both young and elderly patients). After complete remission(CR) achieved, postremission consolidation therapy should be started to prevent relapse, including Allogenic hematopoietic cell transplantation, which is the preferred treatment. When there is not any accessible HLA-matched donor, using an alternate donor has been recommended. <br> 2. Investigational therapy: for patients older than 65 or have more comorbidities and high-risk illnesses or cases who cannot tolerate Cytarabine-based regimen + Daunorubicin, changing their regiments to an investigational therapy could be regarded. (administrate one chemotherapy drug or combine their treatment with non-intensive medications fitting with the patient such as decitabine, azacitidine). After complete remission, postremission therapy has to be regarded.<br> |D04=Patients with relapsed and refractory AML who has an HLA-matched donor accessible for allogenic HCT or cases who attained second complete remission after salvage therapy while there is an available appropriate donor should undergo allogenic hematopoietic cell  transplantation. Those who do not have these conditions have to be treated based on clinical trials (investigational therapy).  }}  
{{familytree/end}}
{{familytree/end}}
Treatment of acute lymphoblastic leukemia includes three phases:<ref name="pmid21220592">{{cite journal| author=Bassan R, Hoelzer D| title=Modern therapy of acute lymphoblastic leukemia. | journal=J Clin Oncol | year= 2011 | volume= 29 | issue= 5 | pages= 532-43 | pmid=21220592 | doi=10.1200/JCO.2010.30.1382 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21220592  }} </ref>
:*Induction therapy, i.e., prednisolone, vincristine, cytarabine <br>
:*Administrating Central Nervous System prophylaxis, i.e., methotrexate
:*Chemotherapy as a maintenance treatment for two years
:*Stem cell transplantation in adults who are eligible while there is a suitable donor


==Do's==
==Do's==
* The content in this section is in bullet points.
:* Before starting the therapy, taking a precise history and physical examination have to be done to diagnose any kind of comorbidities ,i.e. heart failure or renal diseases that affect the prognosis and treatment choices.
 
:*HLA-typing evaluation have to be done for all of the AML cases In the pretreatment assessment.
:*Seven days after the induction phase of chemotherapy ended, bone marrow biopsy must be done in order to assess the remission situation.
:* In the induction chemotherapy process of AML for most of the cases, cytarabine IV infusion should be administrated for seven days consecutively + anthracycline on days one to three.(known as "7+3" regimens)<ref name="pmidhttps://pubmed.ncbi.nlm.nih.gov/9045305">{{cite journal| author=Bishop JF| title=The treatment of adult acute myeloid leukemia. | journal=Semin Oncol | year= 1997 | volume= 24 | issue= 1 | pages= 57-69 | pmid=https://pubmed.ncbi.nlm.nih.gov/9045305 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9045305  }} </ref> <ref name="TallmanWang2019">{{cite journal|last1=Tallman|first1=Martin S.|last2=Wang|first2=Eunice S.|last3=Altman|first3=Jessica K.|last4=Appelbaum|first4=Frederick R.|last5=Bhatt|first5=Vijaya Raj|last6=Bixby|first6=Dale|last7=Coutre|first7=Steven E.|last8=De Lima|first8=Marcos|last9=Fathi|first9=Amir T.|last10=Fiorella|first10=Melanie|last11=Foran|first11=James M.|last12=Hall|first12=Aric C.|last13=Jacoby|first13=Meagan|last14=Lancet|first14=Jeffrey|last15=LeBlanc|first15=Thomas W.|last16=Mannis|first16=Gabriel|last17=Marcucci|first17=Guido|last18=Martin|first18=Michael G.|last19=Mims|first19=Alice|last20=O’Donnell|first20=Margaret R.|last21=Olin|first21=Rebecca|last22=Peker|first22=Deniz|last23=Perl|first23=Alexander|last24=Pollyea|first24=Daniel A.|last25=Pratz|first25=Keith|last26=Prebet|first26=Thomas|last27=Ravandi|first27=Farhad|last28=Shami|first28=Paul J.|last29=Stone|first29=Richard M.|last30=Strickland|first30=Stephen A.|last31=Wieduwilt|first31=Matthew|last32=Gregory|first32=Kristina M.|last33=Hammond|first33=Lydia|last34=Ogba|first34=Ndiya|title=Acute Myeloid Leukemia, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology|journal=Journal of the National Comprehensive Cancer Network|volume=17|issue=6|year=2019|pages=721–749|issn=1540-1405|doi=10.6004/jnccn.2019.0028}}</ref>


==Don'ts==
==Don'ts==
* The content in this section is in bullet points.
:*If the patient with AML has a coagulopathy disorder and is susceptible to bleeding, do not have to undergo lumbar puncture in the workup process before correcting that.
:*Without the assessment of cardiac symptoms and echocardiogram, chemotherapy medications which are cardiotoxic should not be administrated. <ref name="TallmanWang2019">{{cite journal|last1=Tallman|first1=Martin S.|last2=Wang|first2=Eunice S.|last3=Altman|first3=Jessica K.|last4=Appelbaum|first4=Frederick R.|last5=Bhatt|first5=Vijaya Raj|last6=Bixby|first6=Dale|last7=Coutre|first7=Steven E.|last8=De Lima|first8=Marcos|last9=Fathi|first9=Amir T.|last10=Fiorella|first10=Melanie|last11=Foran|first11=James M.|last12=Hall|first12=Aric C.|last13=Jacoby|first13=Meagan|last14=Lancet|first14=Jeffrey|last15=LeBlanc|first15=Thomas W.|last16=Mannis|first16=Gabriel|last17=Marcucci|first17=Guido|last18=Martin|first18=Michael G.|last19=Mims|first19=Alice|last20=O’Donnell|first20=Margaret R.|last21=Olin|first21=Rebecca|last22=Peker|first22=Deniz|last23=Perl|first23=Alexander|last24=Pollyea|first24=Daniel A.|last25=Pratz|first25=Keith|last26=Prebet|first26=Thomas|last27=Ravandi|first27=Farhad|last28=Shami|first28=Paul J.|last29=Stone|first29=Richard M.|last30=Strickland|first30=Stephen A.|last31=Wieduwilt|first31=Matthew|last32=Gregory|first32=Kristina M.|last33=Hammond|first33=Lydia|last34=Ogba|first34=Ndiya|title=Acute Myeloid Leukemia, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology|journal=Journal of the National Comprehensive Cancer Network|volume=17|issue=6|year=2019|pages=721–749|issn=1540-1405|doi=10.6004/jnccn.2019.0028}}</ref>


==References==
==References==
{{Reflist|2}}


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Latest revision as of 19:00, 3 November 2020

Acute leukemia
Resident Survival Guide
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alieh Behjat, M.D.[2]

Synonyms and keywords: Acute lymphocytic leukemia, Acute myeloid leukemia, ALL, AML

Overview

Acute Leukemia is a malignancy of bone marrow myeloid and lymphoblastic precursor cells, in which these poorly differentiated hematopoietic cells proliferate rapidly. Hence, their accumulation would disrupt the performance of bone marrow to produce normal blood cells

Causes

AML and ALL are life-threatening diseases, which would result in death if left untreated. In the majority of cases, etiology is not apparent.

Common Causes of AML


Common Causes of ALL

FIRE

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

  • Focused Initial Rapid Evaluation (FIRE) in AML [4][5]:
 
 
 
 
 
 
 
 
 
 
 
 
 
Obtain patient's medical history and focus on these signs and symptoms:
Fatigue
Weight loss
Anorexia
Bone pain
Bleeding
Early satiety
❑ History of specific and chronic exposures such as alkylating agents, benzene, radiation, or previous chemotherapy
Headache
History of recurrent fever
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient:
Fever
Ecchymosis
Lymphadenopathy
Splenomegaly
Hepatomegaly
❑ Mediastinal mass
❑ Abnormalities in cranial nerve examination
Skin Petechiae
❑ Testicular enlargement <
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Radiologic assessment:
CXR (PA and lateral)
PET or CT scan (if extramedullary disease is doubted based on symptoms and physical exam)
CT, or MRI, and other imaging methods to diagnose ICH, brain or spinal cord tumors, and leptomeningeal disease (if patient presenting notable CNS signs and symptoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bone marrow aspiration and biopsy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  • Focused Initial Rapid Evaluation (FIRE) in ALL:[3] [6] [7]
 
 
 
 
 
 
 
 
 
 
 
 
 
Take a precise medical history and focus on these signs and symptoms:
Fatigue
Anorexia
Bone and joint pain
Bleeding
Weakness and lethargy
❑ History of prior exposures with alkylating agents, radiation, or previous chemotherapy (less prevalent than AML)
Headache
History of bleeding or unexplained bruising
❑ History of congenital syndroms
Night sweats, weight loss and fever(B symptoms)
Abdominal distention
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient:
Fever
Tachycardia
❑ Mediastinal mass
Lymphadenopathy
Splenomegaly
Hepatomegaly
❑ Abnormalities in cranial nerve examination
Skin Petechiae
❑Testicular enlargement (rare)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hematologic evaluation:
CBD including platelets and WBCs)
Uric acid, BUN, Cr, Liver function tests, bilirubin
Lactate dehydrogenase , potassium, phosphates, and calcium
❑ d-dimer, fibrinogen, PT, and PTT
❑ Peripheral blood smear
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Radiologic assessment:
CXR (PA and lateral) to rule out mediastinal masses
❑ Brain CT scan and MRI with contrast if neurologic signs and symptoms have existed
❑ Scrotal ultrasound for assessing testicular involvement
❑ Echocardiogram or cardiac scan
A whole body PET or CT scan when lymphoblastic lymphoma is doubted
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Bone marrow aspiration and biopsy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Diagnosis

Diagnostic criteria of acute myeloid leukemia and acute lymphoblastic leukemia are similar to one another.

  • According to the 2016 WHO criteria observing ≥20% blasts in the bone marrow biopsy or peripheral blood smear is diagnostic for AML. These genetic abnormalities in AML are diagnostic even with less than 20% marrow blasts: inv(16), t(16;16), t(8;21), and t(15;17).[8]
  • Presenting ≥20% of leukemic lymphoblasts in bone marrow aspirate and biopsy would prove ALL.[9]

Treatment

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treatment of a patient with definitive AML[10] [11] [12]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treating for the first time(new case)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cases with relapsed/refractory AML
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Favorable-Risk Cytogenetics
 
 
 
 
 
Intermediate-Risk Cytogenetics
 
 
 
 
 
 
 
 
Poor-Risk Cytogenetics
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Salvage therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Select one of these therapies:
❑ 1. Induction treatment: Cytarabine-based regimen + Daunorubicin. If a complete remission is achieved, postremission consolidation therapy as maintenance should be started: intermediate dose of Cytarabine)
❑ 2.Investigational drugs(clinical trial): for cases aged younger than 60 years, a standard chemotherapy regimen including a backbone of Cytarabine + Anthracycline has been recommended. After complete remission, postremission therapy have to be regarded.
 
 
 
 
 
Select one of these treatments:

❑ 1. Investigational therapy: for patients older than 65 or have more comorbidities and high-risk illnesses or cases who cannot tolerate Cytarabine-based regimen + Daunorubicin, changing their regiments to an investigational therapy could be regarded. (administrate one chemotherapy drug or combine their treatment with non-intensive medications fitting with the patient such as decitabine, azacitidine). After complete remission, postremission therapy have to be regarded.
❑ 2. Induction treatment: Cytarabine-based regimen + Daunorubicin (could be suitable for young and elderly patients). If complete remission(CR) is achieved, postremission consolidation therapy as maintenance should be started to prevent relapse, including:

  • Allogenic hematopoietic cell transplantation, which is the preferred treatment, or
  • If the patient is younger than 60 years autologous hematopoietic cell transplantation is recommended, or
  • Intermediate dose of Cytarabine
 
 
 
 
 
 
 
 
Select one of these therapies:
1. Induction treatment: Cytarabine-based regimen + Daunorubicin (could be suitable for both young and elderly patients). After complete remission(CR) achieved, postremission consolidation therapy should be started to prevent relapse, including Allogenic hematopoietic cell transplantation, which is the preferred treatment. When there is not any accessible HLA-matched donor, using an alternate donor has been recommended.
2. Investigational therapy: for patients older than 65 or have more comorbidities and high-risk illnesses or cases who cannot tolerate Cytarabine-based regimen + Daunorubicin, changing their regiments to an investigational therapy could be regarded. (administrate one chemotherapy drug or combine their treatment with non-intensive medications fitting with the patient such as decitabine, azacitidine). After complete remission, postremission therapy has to be regarded.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patients with relapsed and refractory AML who has an HLA-matched donor accessible for allogenic HCT or cases who attained second complete remission after salvage therapy while there is an available appropriate donor should undergo allogenic hematopoietic cell transplantation. Those who do not have these conditions have to be treated based on clinical trials (investigational therapy).
 


Treatment of acute lymphoblastic leukemia includes three phases:[13]

  • Induction therapy, i.e., prednisolone, vincristine, cytarabine
  • Administrating Central Nervous System prophylaxis, i.e., methotrexate
  • Chemotherapy as a maintenance treatment for two years
  • Stem cell transplantation in adults who are eligible while there is a suitable donor

Do's

  • Before starting the therapy, taking a precise history and physical examination have to be done to diagnose any kind of comorbidities ,i.e. heart failure or renal diseases that affect the prognosis and treatment choices.
  • HLA-typing evaluation have to be done for all of the AML cases In the pretreatment assessment.
  • Seven days after the induction phase of chemotherapy ended, bone marrow biopsy must be done in order to assess the remission situation.
  • In the induction chemotherapy process of AML for most of the cases, cytarabine IV infusion should be administrated for seven days consecutively + anthracycline on days one to three.(known as "7+3" regimens)[14] [4]

Don'ts

  • If the patient with AML has a coagulopathy disorder and is susceptible to bleeding, do not have to undergo lumbar puncture in the workup process before correcting that.
  • Without the assessment of cardiac symptoms and echocardiogram, chemotherapy medications which are cardiotoxic should not be administrated. [4]

References

  1. Cancer Genome Atlas Research Network. Ley TJ, Miller C, Ding L, Raphael BJ, Mungall AJ; et al. (2013). "Genomic and epigenomic landscapes of adult de novo acute myeloid leukemia". N Engl J Med. 368 (22): 2059–74. doi:10.1056/NEJMoa1301689. PMC 3767041. PMID 23634996.
  2. Thirman MJ, Gill HJ, Burnett RC, Mbangkollo D, McCabe NR, Kobayashi H; et al. (1993). "Rearrangement of the MLL gene in acute lymphoblastic and acute myeloid leukemias with 11q23 chromosomal translocations". N Engl J Med. 329 (13): 909–14. doi:10.1056/NEJM199309233291302. PMID 8361504.
  3. 3.0 3.1 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.
  4. 4.0 4.1 4.2 Tallman, Martin S.; Wang, Eunice S.; Altman, Jessica K.; Appelbaum, Frederick R.; Bhatt, Vijaya Raj; Bixby, Dale; Coutre, Steven E.; De Lima, Marcos; Fathi, Amir T.; Fiorella, Melanie; Foran, James M.; Hall, Aric C.; Jacoby, Meagan; Lancet, Jeffrey; LeBlanc, Thomas W.; Mannis, Gabriel; Marcucci, Guido; Martin, Michael G.; Mims, Alice; O’Donnell, Margaret R.; Olin, Rebecca; Peker, Deniz; Perl, Alexander; Pollyea, Daniel A.; Pratz, Keith; Prebet, Thomas; Ravandi, Farhad; Shami, Paul J.; Stone, Richard M.; Strickland, Stephen A.; Wieduwilt, Matthew; Gregory, Kristina M.; Hammond, Lydia; Ogba, Ndiya (2019). "Acute Myeloid Leukemia, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology". Journal of the National Comprehensive Cancer Network. 17 (6): 721–749. doi:10.6004/jnccn.2019.0028. ISSN 1540-1405.
  5. Jameson, J (2018). Harrison's principles of internal medicine. New York: McGraw-Hill Education. ISBN 978-1259643996.
  6. Brown P, Inaba H, Annesley C, Beck J, Colace S, Dallas M; et al. (2020). "Pediatric Acute Lymphoblastic Leukemia, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology". J Natl Compr Canc Netw. 18 (1): 81–112. doi:10.6004/jnccn.2020.0001. PMID 31910389.
  7. Rose-Inman H, Kuehl D (2014). "Acute leukemia". Emerg Med Clin North Am. 32 (3): 579–96. doi:10.1016/j.emc.2014.04.004. PMID 25060251.
  8. Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J; et al. (1999). "The World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. Report of the Clinical Advisory Committee meeting, Airlie House, Virginia, November, 1997". Ann Oncol. 10 (12): 1419–32. doi:10.1023/a:1008375931236. PMID 10643532.
  9. Chiaretti S, Zini G, Bassan R (2014). "Diagnosis and subclassification of acute lymphoblastic leukemia". Mediterr J Hematol Infect Dis. 6 (1): e2014073. doi:10.4084/MJHID.2014.073. PMC 4235437. PMID 25408859.
  10. Döhner H, Weisdorf DJ, Bloomfield CD (2015). "Acute Myeloid Leukemia". N Engl J Med. 373 (12): 1136–52. doi:10.1056/NEJMra1406184. PMID 26376137.
  11. 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.
  12. Jameson, J (2018). Harrison's principles of internal medicine. New York: McGraw-Hill Education. ISBN 978-1259643996.
  13. Bassan R, Hoelzer D (2011). "Modern therapy of acute lymphoblastic leukemia". J Clin Oncol. 29 (5): 532–43. doi:10.1200/JCO.2010.30.1382. PMID 21220592.
  14. Bishop JF (1997). "The treatment of adult acute myeloid leukemia". Semin Oncol. 24 (1): 57–69. PMID https://pubmed.ncbi.nlm.nih.gov/9045305 Check |pmid= value (help).