eMedicine Specialties > Hematology > Stem Cells and Disorders

Acute Myelogenous Leukemia: Follow-up

Author: Karen Seiter, MD, Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College
Contributor Information and Disclosures

Updated: Mar 4, 2009

Follow-up

Further Inpatient Care

  • Patients with acute myelogenous leukemia (AML) require readmission for consolidation chemotherapy or for the management of toxic effects of chemotherapy.

Further Outpatient Care

  • Patients should come to the office for monitoring of disease status and chemotherapy effects.

Transfer

  • Patients with acute myelogenous leukemia (AML) are best treated at a center whose staff has significant experience in the treatment of leukemia. Patients should be transferred to an appropriate (generally tertiary care) hospital if they are admitted to hospitals without appropriate blood product support, leukapheresis capabilities, or physicians and nurses familiar with the treatment of leukemia patients.

Deterrence/Prevention

  • When receiving chemotherapy, patients should avoid exposure to crowds and people with contagious illnesses, especially children with viral infections.

Complications

  • Death in patients with acute myelogenous leukemia (AML) may occur because of uncontrolled infection or hemorrhage. This may happen even after use of appropriate blood product and antibiotic support.
  • The most common complication is failure of the leukemia to respond to chemotherapy. The prognosis for these patients is poor because their disease usually does not respond to other chemotherapy regimens.

Prognosis

  • The prognosis relies on several factors.
    • Increasing age is an adverse factor, because older patients more frequently have a previous antecedent hematologic disorder along with comorbid medical conditions that compromise the ability to give full doses of chemotherapy.
    • A previous antecedent hematologic disorder is associated with a poor outcome to therapy. The most common antecedent hematologic disorder is MDS.
    • Cytogenetic analysis of the bone marrow is one of the most important prognostic factors. Patients with t(8;21), t(15;17), or inversion 16 have the best prognosis, with long-term survival rates of approximately 65%. Patients with normal cytogenetic findings have an intermediate prognosis and have a long-term survival rate of approximately 25%. Patients with poor-risk cytogenetic findings (especially -7, -5) have a poor prognosis, with a long-term survival rate of less than 10%.
    • Other cytogenetic abnormalities, including +8, 11q23, and miscellaneous, have been reported to be intermediate risk in some series and poor risk in others.
    • The presence of an FLT3 mutation is associated with a poorer prognosis. Mutations in CEBPA are associated with a longer remission duration and longer overall survival. Mutations in NPM are associated with an increased response to chemotherapy.

Patient Education

  • Patients with acute myelogenous leukemia (AML) should be instructed to call their healthcare providers immediately if they are febrile or have signs of bleeding.

Miscellaneous

Medicolegal Pitfalls

  • The most important medicolegal pitfall is the failure to rapidly distinguish a patient with acute leukemia from patients with less urgent hematologic disorders. Pancytopenia, for example, can be caused by a large variety of diseases of varying severity, including vitamin deficiencies and autoimmune disease. However, pancytopenia due to acute promyelocytic leukemia (APL) is a life-threatening emergency that must be aggressively treated immediately. The easiest way to avoid misdiagnosis is to review the peripheral blood smear at the time of initial evaluation of all patients with hematologic disorders.
  • A second pitfall is failure to immediately treat a patient with neutropenic fever or infection with broad spectrum antibiotics.
  • A third pitfall is failure to give appropriate transfusion support to a patient with acute leukemia. This includes transfusion of platelets and clotting factors (fresh frozen plasma, cryoprecipitate) as guided by the patient's blood test results and bleeding history. Blood products must be irradiated to prevent transfusion-associated graft versus host disease.
 


More on Acute Myelogenous Leukemia

Overview: Acute Myelogenous Leukemia
Differential Diagnoses & Workup: Acute Myelogenous Leukemia
Treatment & Medication: Acute Myelogenous Leukemia
Follow-up: Acute Myelogenous Leukemia
References
Further Reading
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Keywords

acute myelogenous leukemia, acute myeloid leukemia, AML, acute nonlymphoblastic leukemia, acute nonlymphocytic leukemia, acute non-lymphoblastic leukemia, acute non-lymphocytic leukemia, nonlymphoblastic leukemia, nonlymphocytic leukemia, non-lymphoblastic leukemia, non-lymphocytic leukemia, leukemia, cancer, bone marrow cancer, bone marrow failure,

radiation exposure, Bloom syndrome, Down syndrome, trisomy 21, congenital neutropenia, Fanconi anemia, neurofibromatosis, acute promyelocytic leukemia, APL, M3, promyelocytic leukemia, immature bone marrow cells, chromosomal translocation, genetic abnormality, cytogenetic abnormalities, anemia, thrombocytopenia, neutropenia, myelodysplastic syndrome, MDS, antecedent hematologic disorder, AHD, disseminated intravascular coagulation, DIC,

organ infiltration with leukemic cells, leukostasis, familial erythroleukemia, bone marrow transplantation, bone marrow transplant, BMT, allogeneic BMT, autologous BMT, alkylating agents, topoisomerase-II inhibitors, acute monocytic leukemia, M5, acute myelomonocytic leukemia, M4, blast count, acute undifferentiated leukemia, M0, acute megakaryocytic leukemia, M7, bone marrow aspiration, arabinosylcytosine, araC, ara-C, fibrinolysis,

all-trans-retinoic acid, ATRA, retinoic acid syndrome, malignant disease of bone marrow, bleeding gums, multiple ecchymoses, gingivitis, petechiae, leukemia cutis, chloromata, soft-tissue chloroma, granulocytic sarcoma, Li-Fraumeni syndrome, aplastic anemia, pancytopenia, myelofibrosis, paroxysmal nocturnal hemoglobinuria, polycythemia vera

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Contributor Information and Disclosures

Author

Karen Seiter, MD, Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College
Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, and American Society of Hematology
Disclosure: Novartis Honoraria Speaking and teaching; Schering Honoraria Speaking and teaching; Cephalon Honoraria Speaking and teaching

Medical Editor

Clarence Sarkodee-Adoo, MD, Consulting Staff, Department of Bone Marrow Transplantation, City of Hope Samaritan BMT Program
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Sacher, MB, BCh, MD, FRCPC, Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center
Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Society of Hematology
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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