Acute megakaryoblastic leukemia natural history, complications and prognosis: Difference between revisions
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{{Acute megakaryoblastic leukemia}} | {{Acute megakaryoblastic leukemia}} | ||
== Natural History: == | ==Natural History:== | ||
*Clonal proliferation of early megakaryoblasts in the bone marrow results in acute megakaryoblastic leukemia (AMKL).<ref name="pmid11001891">{{cite journal| author=Tallman MS, Neuberg D, Bennett JM, Francois CJ, Paietta E, Wiernik PH | display-authors=etal| title=Acute megakaryocytic leukemia: the Eastern Cooperative Oncology Group experience. | journal=Blood | year= 2000 | volume= 96 | issue= 7 | pages= 2405-11 | pmid=11001891 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11001891 }}</ref> It has a bimodal onset of presentation—occurs both in the pediatric age group (<4 years) and adults.<ref name="GassmannLöffler2009">{{cite journal|last1=Gassmann|first1=Winfried|last2=Löffler|first2=Helmut|title=Acute Megakaryoblastic Leukemia|journal=Leukemia & Lymphoma|volume=18|issue=sup1|year=2009|pages=69–73|issn=1042-8194|doi=10.3109/10428199509075307}}</ref> | *Clonal proliferation of early [[megakaryoblasts]] in the bone marrow results in acute megakaryoblastic leukemia (AMKL).<ref name="pmid11001891">{{cite journal| author=Tallman MS, Neuberg D, Bennett JM, Francois CJ, Paietta E, Wiernik PH | display-authors=etal| title=Acute megakaryocytic leukemia: the Eastern Cooperative Oncology Group experience. | journal=Blood | year= 2000 | volume= 96 | issue= 7 | pages= 2405-11 | pmid=11001891 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11001891 }}</ref> It has a bimodal onset of presentation—occurs both in the pediatric age group (<4 years) and adults.<ref name="GassmannLöffler2009">{{cite journal|last1=Gassmann|first1=Winfried|last2=Löffler|first2=Helmut|title=Acute Megakaryoblastic Leukemia|journal=Leukemia & Lymphoma|volume=18|issue=sup1|year=2009|pages=69–73|issn=1042-8194|doi=10.3109/10428199509075307}}</ref> | ||
*In childhood, it is more prevalent in patients with Down syndrome. While it is rare in adults, approximately 0.6% (24/3603) reported in the GIMEMA trial.<ref name="PaganoPulsoni2002">{{cite journal|last1=Pagano|first1=L|last2=Pulsoni|first2=A|last3=Vignetti|first3=M|last4=Mele|first4=L|last5=Fianchi|first5=L|last6=Petti|first6=MC|last7=Mirto|first7=S|last8=Falcucci|first8=P|last9=Fazi|first9=P|last10=Broccia|first10=G|last11=Specchia|first11=G|last12=Di Raimondo|first12=F|last13=Pacilli|first13=L|last14=Leoni|first14=P|last15=Ladogana|first15=S|last16=Gallo|first16=E|last17=Venditti|first17=A|last18=Avanzi|first18=G|last19=Camera|first19=A|last20=Liso|first20=V|last21=Leone|first21=G|last22=Mandelli|first22=F|title=Acute megakaryoblastic leukemia: experience of GIMEMA trials|journal=Leukemia|volume=16|issue=9|year=2002|pages=1622–1626|issn=0887-6924|doi=10.1038/sj.leu.2402618}}</ref> Due to the rarity of this subtype of hematological malignancy, limited data is available on the natural course or prognosis. | *In childhood, it is more prevalent in patients with Down syndrome. While it is rare in adults, approximately 0.6% (24/3603) reported in the [[GIMEMA trial]].<ref name="PaganoPulsoni2002">{{cite journal|last1=Pagano|first1=L|last2=Pulsoni|first2=A|last3=Vignetti|first3=M|last4=Mele|first4=L|last5=Fianchi|first5=L|last6=Petti|first6=MC|last7=Mirto|first7=S|last8=Falcucci|first8=P|last9=Fazi|first9=P|last10=Broccia|first10=G|last11=Specchia|first11=G|last12=Di Raimondo|first12=F|last13=Pacilli|first13=L|last14=Leoni|first14=P|last15=Ladogana|first15=S|last16=Gallo|first16=E|last17=Venditti|first17=A|last18=Avanzi|first18=G|last19=Camera|first19=A|last20=Liso|first20=V|last21=Leone|first21=G|last22=Mandelli|first22=F|title=Acute megakaryoblastic leukemia: experience of GIMEMA trials|journal=Leukemia|volume=16|issue=9|year=2002|pages=1622–1626|issn=0887-6924|doi=10.1038/sj.leu.2402618}}</ref> Due to the rarity of this subtype of hematological malignancy, limited data is available on the natural course or [[prognosis]]. | ||
==Complications:== | ==Complications:== | ||
#Periorbital swelling | #Periorbital swelling | ||
#Periosteal elevation | #[[Periosteal elevation]] | ||
#Osteolytic lesions, especially in long bones, e.g., femur<ref name="AthaleKaste2002">{{cite journal|last1=Athale|first1=Uma H.|last2=Kaste|first2=Sue C.|last3=Razzouk|first3=Bassem I.|last4=Rubnitz|first4=Jeffrey E.|last5=Ribeiro|first5=Raul C.|title=Skeletal Manifestations of Pediatric Acute Megakaryoblastic Leukemia|journal=Journal of Pediatric Hematology/Oncology|volume=24|issue=7|year=2002|pages=561–565|issn=1077-4114|doi=10.1097/00043426-200210000-00014}}</ref> | #Osteolytic lesions, especially in long bones, e.g., femur<ref name="AthaleKaste2002">{{cite journal|last1=Athale|first1=Uma H.|last2=Kaste|first2=Sue C.|last3=Razzouk|first3=Bassem I.|last4=Rubnitz|first4=Jeffrey E.|last5=Ribeiro|first5=Raul C.|title=Skeletal Manifestations of Pediatric Acute Megakaryoblastic Leukemia|journal=Journal of Pediatric Hematology/Oncology|volume=24|issue=7|year=2002|pages=561–565|issn=1077-4114|doi=10.1097/00043426-200210000-00014}}</ref> | ||
#Osteoporosis with pathologic fractures<ref name="AthaleKaste20022">{{cite journal|last1=Athale|first1=Uma H.|last2=Kaste|first2=Sue C.|last3=Razzouk|first3=Bassem I.|last4=Rubnitz|first4=Jeffrey E.|last5=Ribeiro|first5=Raul C.|title=Skeletal Manifestations of Pediatric Acute Megakaryoblastic Leukemia|journal=Journal of Pediatric Hematology/Oncology|volume=24|issue=7|year=2002|pages=561–565|issn=1077-4114|doi=10.1097/00043426-200210000-00014}}</ref><ref name="KushnerWeinstein1980">{{cite journal|last1=Kushner|first1=David C.|last2=Weinstein|first2=Howard J.|last3=Kirkpatrick|first3=John A.|title=The radiologic diagnosis of leukemia and lymphoma in children|journal=Seminars in Roentgenology|volume=15|issue=4|year=1980|pages=316–334|issn=0037198X|doi=10.1016/0037-198X(80)90027-9}}</ref> | #[[Osteoporosis]] with pathologic fractures<ref name="AthaleKaste20022">{{cite journal|last1=Athale|first1=Uma H.|last2=Kaste|first2=Sue C.|last3=Razzouk|first3=Bassem I.|last4=Rubnitz|first4=Jeffrey E.|last5=Ribeiro|first5=Raul C.|title=Skeletal Manifestations of Pediatric Acute Megakaryoblastic Leukemia|journal=Journal of Pediatric Hematology/Oncology|volume=24|issue=7|year=2002|pages=561–565|issn=1077-4114|doi=10.1097/00043426-200210000-00014}}</ref><ref name="KushnerWeinstein1980">{{cite journal|last1=Kushner|first1=David C.|last2=Weinstein|first2=Howard J.|last3=Kirkpatrick|first3=John A.|title=The radiologic diagnosis of leukemia and lymphoma in children|journal=Seminars in Roentgenology|volume=15|issue=4|year=1980|pages=316–334|issn=0037198X|doi=10.1016/0037-198X(80)90027-9}}</ref> | ||
#Sweet syndrome (SS)<ref name="pmid8479086">{{cite journal| author=Yokoyama K, Kojima M, Komatsumoto S, Nara M, Ohyashiki K, Ikeda Y | display-authors=etal| title=[Acute megakaryoblastic leukemia associated with Sweet's syndrome, including review of the literature]. | journal=Rinsho Ketsueki | year= 1993 | volume= 34 | issue= 3 | pages= 341-7 | pmid=8479086 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8479086 }}</ref> | #[[Sweet syndrome]] (SS)<ref name="pmid8479086">{{cite journal| author=Yokoyama K, Kojima M, Komatsumoto S, Nara M, Ohyashiki K, Ikeda Y | display-authors=etal| title=[Acute megakaryoblastic leukemia associated with Sweet's syndrome, including review of the literature]. | journal=Rinsho Ketsueki | year= 1993 | volume= 34 | issue= 3 | pages= 341-7 | pmid=8479086 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8479086 }}</ref> | ||
#Leukemia cutis<ref name="pmid1758056">{{cite journal| author=Tsurumi H, Takahashi T, Koshino Y, Oyama M, Matsutomo K, Yasuda M | display-authors=etal| title=[Acute megakaryoblastic leukemia with leukemia cutis, meningeal leukemia, and myelofibrosis]. | journal=Rinsho Ketsueki | year= 1991 | volume= 32 | issue= 11 | pages= 1475-80 | pmid=1758056 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1758056 }}</ref> | #[[Leukemia cutis]]<ref name="pmid1758056">{{cite journal| author=Tsurumi H, Takahashi T, Koshino Y, Oyama M, Matsutomo K, Yasuda M | display-authors=etal| title=[Acute megakaryoblastic leukemia with leukemia cutis, meningeal leukemia, and myelofibrosis]. | journal=Rinsho Ketsueki | year= 1991 | volume= 32 | issue= 11 | pages= 1475-80 | pmid=1758056 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1758056 }}</ref> | ||
#Hypercalcemia<ref name="pmid19415024">{{cite journal| author=Qayed M, Ahmed I, Valentini RP, Cushing B, Rajpurkar M| title=Hypercalcemia in pediatric acute megakaryocytic leukemia: case report and review of the literature. | journal=J Pediatr Hematol Oncol | year= 2009 | volume= 31 | issue= 5 | pages= 373-6 | pmid=19415024 | doi=10.1097/MPH.0b013e31819a5d29 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19415024 }}</ref> | #[[Hypercalcemia]]<ref name="pmid19415024">{{cite journal| author=Qayed M, Ahmed I, Valentini RP, Cushing B, Rajpurkar M| title=Hypercalcemia in pediatric acute megakaryocytic leukemia: case report and review of the literature. | journal=J Pediatr Hematol Oncol | year= 2009 | volume= 31 | issue= 5 | pages= 373-6 | pmid=19415024 | doi=10.1097/MPH.0b013e31819a5d29 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19415024 }}</ref> | ||
==Prognosis:== | ==Prognosis:== | ||
Apart from AMKL in Down syndrome patients, the prognosis of AMKL is poor. The efficacy profile of AMKL in Down syndrome patients is favorable, but it comes with a lot of treatment-related toxicity. | Apart from AMKL in [[Down syndrome]] patients, the prognosis of AMKL is poor. The efficacy profile of AMKL in Down syndrome patients is favorable, but it comes with a lot of treatment-related toxicity. | ||
*According to the Children’s Oncology Group (COG) AML0431 trial results, the 5-year event-free survival and overall survival rates were 90% and 93% in 204 eligible Down syndrome with AMKL patients.<ref name="TaubBerman2017">{{cite journal|last1=Taub|first1=Jeffrey W.|last2=Berman|first2=Jason N.|last3=Hitzler|first3=Johann K.|last4=Sorrell|first4=April D.|last5=Lacayo|first5=Norman J.|last6=Mast|first6=Kelley|last7=Head|first7=David|last8=Raimondi|first8=Susana|last9=Hirsch|first9=Betsy|last10=Ge|first10=Yubin|last11=Gerbing|first11=Robert B.|last12=Wang|first12=Yi-Cheng|last13=Alonzo|first13=Todd A.|last14=Campana|first14=Dario|last15=Coustan-Smith|first15=Elaine|last16=Mathew|first16=Prasad|last17=Gamis|first17=Alan S.|title=Improved outcomes for myeloid leukemia of Down syndrome: a report from the Children’s Oncology Group AAML0431 trial|journal=Blood|volume=129|issue=25|year=2017|pages=3304–3313|issn=0006-4971|doi=10.1182/blood-2017-01-764324}}</ref> | *According to the Children’s Oncology Group (COG) AML0431 trial results, the 5-year event-free survival and [[overall survival]] rates were 90% and 93% in 204 eligible Down syndrome with AMKL patients.<ref name="TaubBerman2017">{{cite journal|last1=Taub|first1=Jeffrey W.|last2=Berman|first2=Jason N.|last3=Hitzler|first3=Johann K.|last4=Sorrell|first4=April D.|last5=Lacayo|first5=Norman J.|last6=Mast|first6=Kelley|last7=Head|first7=David|last8=Raimondi|first8=Susana|last9=Hirsch|first9=Betsy|last10=Ge|first10=Yubin|last11=Gerbing|first11=Robert B.|last12=Wang|first12=Yi-Cheng|last13=Alonzo|first13=Todd A.|last14=Campana|first14=Dario|last15=Coustan-Smith|first15=Elaine|last16=Mathew|first16=Prasad|last17=Gamis|first17=Alan S.|title=Improved outcomes for myeloid leukemia of Down syndrome: a report from the Children’s Oncology Group AAML0431 trial|journal=Blood|volume=129|issue=25|year=2017|pages=3304–3313|issn=0006-4971|doi=10.1182/blood-2017-01-764324}}</ref> | ||
*Similarly, the reported 3-year overall survival rate was 100% among 3 AMKL with Down syndrome patients while (47±12%) in non-Down syndrome patients.<ref name="QiMao2020">{{cite journal|last1=Qi|first1=Haixiao|last2=Mao|first2=Yan|last3=Cao|first3=Qian|last4=Sun|first4=Xingzhen|last5=Kuai|first5=Wenxia|last6=Song|first6=Junhong|last7=Ma|first7=Li|last8=Hong|first8=Ze|last9=Hu|first9=Jian|last10=Zhou|first10=Guoping|title=Clinical Characteristics and Prognosis of 27 Patients with Childhood Acute Megakaryoblastic Leukemia|journal=Medical Science Monitor|volume=26|year=2020|issn=1643-3750|doi=10.12659/MSM.922662}}</ref> | *Similarly, the reported 3-year overall survival rate was 100% among 3 AMKL with Down syndrome patients while (47±12%) in non-Down syndrome patients.<ref name="QiMao2020">{{cite journal|last1=Qi|first1=Haixiao|last2=Mao|first2=Yan|last3=Cao|first3=Qian|last4=Sun|first4=Xingzhen|last5=Kuai|first5=Wenxia|last6=Song|first6=Junhong|last7=Ma|first7=Li|last8=Hong|first8=Ze|last9=Hu|first9=Jian|last10=Zhou|first10=Guoping|title=Clinical Characteristics and Prognosis of 27 Patients with Childhood Acute Megakaryoblastic Leukemia|journal=Medical Science Monitor|volume=26|year=2020|issn=1643-3750|doi=10.12659/MSM.922662}}</ref> | ||
*The 5-year overall survival rate in AMKL was 10.6% versus 17.5% in non-M7 Acute Myeloid leukemia subtypes.<ref name="GiriPathak2014">{{cite journal|last1=Giri|first1=Smith|last2=Pathak|first2=Ranjan|last3=Prouet|first3=Philippe|last4=Li|first4=Bojia|last5=Martin|first5=Mike G.|title=Acute megakaryocytic leukemia is associated with worse outcomes than other types of acute myeloid leukemia|journal=Blood|volume=124|issue=25|year=2014|pages=3833–3834|issn=0006-4971|doi=10.1182/blood-2014-09-603415}}</ref> Currently, chemotherapy and Allo-BMT are main therapy. Treatment-related toxicity is a big challenge. To address this issue, elaborated large future clinical studies are required. | *The 5-year overall survival rate in AMKL was 10.6% versus 17.5% in non-M7 [[Acute Myeloid leukemia|Acute myeloid leukemia]] subtypes.<ref name="GiriPathak2014">{{cite journal|last1=Giri|first1=Smith|last2=Pathak|first2=Ranjan|last3=Prouet|first3=Philippe|last4=Li|first4=Bojia|last5=Martin|first5=Mike G.|title=Acute megakaryocytic leukemia is associated with worse outcomes than other types of acute myeloid leukemia|journal=Blood|volume=124|issue=25|year=2014|pages=3833–3834|issn=0006-4971|doi=10.1182/blood-2014-09-603415}}</ref> Currently, [[chemotherapy]] and [[Allo-BMT|allogenic bone marrow transplant]] (Allo-BMT) are main therapy. Treatment-related toxicity is a big challenge. To address this issue, elaborated large future clinical studies are required. | ||
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Natural History:
- Clonal proliferation of early megakaryoblasts in the bone marrow results in acute megakaryoblastic leukemia (AMKL).[1] It has a bimodal onset of presentation—occurs both in the pediatric age group (<4 years) and adults.[2]
- In childhood, it is more prevalent in patients with Down syndrome. While it is rare in adults, approximately 0.6% (24/3603) reported in the GIMEMA trial.[3] Due to the rarity of this subtype of hematological malignancy, limited data is available on the natural course or prognosis.
Complications:
- Periorbital swelling
- Periosteal elevation
- Osteolytic lesions, especially in long bones, e.g., femur[4]
- Osteoporosis with pathologic fractures[5][6]
- Sweet syndrome (SS)[7]
- Leukemia cutis[8]
- Hypercalcemia[9]
Prognosis:
Apart from AMKL in Down syndrome patients, the prognosis of AMKL is poor. The efficacy profile of AMKL in Down syndrome patients is favorable, but it comes with a lot of treatment-related toxicity.
- According to the Children’s Oncology Group (COG) AML0431 trial results, the 5-year event-free survival and overall survival rates were 90% and 93% in 204 eligible Down syndrome with AMKL patients.[10]
- Similarly, the reported 3-year overall survival rate was 100% among 3 AMKL with Down syndrome patients while (47±12%) in non-Down syndrome patients.[11]
- The 5-year overall survival rate in AMKL was 10.6% versus 17.5% in non-M7 Acute myeloid leukemia subtypes.[12] Currently, chemotherapy and allogenic bone marrow transplant (Allo-BMT) are main therapy. Treatment-related toxicity is a big challenge. To address this issue, elaborated large future clinical studies are required.
References
- ↑ Tallman MS, Neuberg D, Bennett JM, Francois CJ, Paietta E, Wiernik PH; et al. (2000). "Acute megakaryocytic leukemia: the Eastern Cooperative Oncology Group experience". Blood. 96 (7): 2405–11. PMID 11001891.
- ↑ Gassmann, Winfried; Löffler, Helmut (2009). "Acute Megakaryoblastic Leukemia". Leukemia & Lymphoma. 18 (sup1): 69–73. doi:10.3109/10428199509075307. ISSN 1042-8194.
- ↑ Pagano, L; Pulsoni, A; Vignetti, M; Mele, L; Fianchi, L; Petti, MC; Mirto, S; Falcucci, P; Fazi, P; Broccia, G; Specchia, G; Di Raimondo, F; Pacilli, L; Leoni, P; Ladogana, S; Gallo, E; Venditti, A; Avanzi, G; Camera, A; Liso, V; Leone, G; Mandelli, F (2002). "Acute megakaryoblastic leukemia: experience of GIMEMA trials". Leukemia. 16 (9): 1622–1626. doi:10.1038/sj.leu.2402618. ISSN 0887-6924.
- ↑ Athale, Uma H.; Kaste, Sue C.; Razzouk, Bassem I.; Rubnitz, Jeffrey E.; Ribeiro, Raul C. (2002). "Skeletal Manifestations of Pediatric Acute Megakaryoblastic Leukemia". Journal of Pediatric Hematology/Oncology. 24 (7): 561–565. doi:10.1097/00043426-200210000-00014. ISSN 1077-4114.
- ↑ Athale, Uma H.; Kaste, Sue C.; Razzouk, Bassem I.; Rubnitz, Jeffrey E.; Ribeiro, Raul C. (2002). "Skeletal Manifestations of Pediatric Acute Megakaryoblastic Leukemia". Journal of Pediatric Hematology/Oncology. 24 (7): 561–565. doi:10.1097/00043426-200210000-00014. ISSN 1077-4114.
- ↑ Kushner, David C.; Weinstein, Howard J.; Kirkpatrick, John A. (1980). "The radiologic diagnosis of leukemia and lymphoma in children". Seminars in Roentgenology. 15 (4): 316–334. doi:10.1016/0037-198X(80)90027-9. ISSN 0037-198X.
- ↑ Yokoyama K, Kojima M, Komatsumoto S, Nara M, Ohyashiki K, Ikeda Y; et al. (1993). "[Acute megakaryoblastic leukemia associated with Sweet's syndrome, including review of the literature]". Rinsho Ketsueki. 34 (3): 341–7. PMID 8479086.
- ↑ Tsurumi H, Takahashi T, Koshino Y, Oyama M, Matsutomo K, Yasuda M; et al. (1991). "[Acute megakaryoblastic leukemia with leukemia cutis, meningeal leukemia, and myelofibrosis]". Rinsho Ketsueki. 32 (11): 1475–80. PMID 1758056.
- ↑ Qayed M, Ahmed I, Valentini RP, Cushing B, Rajpurkar M (2009). "Hypercalcemia in pediatric acute megakaryocytic leukemia: case report and review of the literature". J Pediatr Hematol Oncol. 31 (5): 373–6. doi:10.1097/MPH.0b013e31819a5d29. PMID 19415024.
- ↑ Taub, Jeffrey W.; Berman, Jason N.; Hitzler, Johann K.; Sorrell, April D.; Lacayo, Norman J.; Mast, Kelley; Head, David; Raimondi, Susana; Hirsch, Betsy; Ge, Yubin; Gerbing, Robert B.; Wang, Yi-Cheng; Alonzo, Todd A.; Campana, Dario; Coustan-Smith, Elaine; Mathew, Prasad; Gamis, Alan S. (2017). "Improved outcomes for myeloid leukemia of Down syndrome: a report from the Children's Oncology Group AAML0431 trial". Blood. 129 (25): 3304–3313. doi:10.1182/blood-2017-01-764324. ISSN 0006-4971.
- ↑ Qi, Haixiao; Mao, Yan; Cao, Qian; Sun, Xingzhen; Kuai, Wenxia; Song, Junhong; Ma, Li; Hong, Ze; Hu, Jian; Zhou, Guoping (2020). "Clinical Characteristics and Prognosis of 27 Patients with Childhood Acute Megakaryoblastic Leukemia". Medical Science Monitor. 26. doi:10.12659/MSM.922662. ISSN 1643-3750.
- ↑ Giri, Smith; Pathak, Ranjan; Prouet, Philippe; Li, Bojia; Martin, Mike G. (2014). "Acute megakaryocytic leukemia is associated with worse outcomes than other types of acute myeloid leukemia". Blood. 124 (25): 3833–3834. doi:10.1182/blood-2014-09-603415. ISSN 0006-4971.