Acute monocytic leukemia

Acute monocytic leukemia
Classification and external resources
Specialty	Hematology and oncology
ICD-10	C93.0
ICD-9-CM	206.0
MeSH	D007948

Acute monocytic leukemia (AMoL, or AML-M5)^[1] is considered a type of acute myeloid leukemia.

Diagnosis

In order to fulfill World Health Organization (WHO) criteria for AML-5, a patient must have greater than 20% blasts in the bone marrow, and of these, greater than 80% must be of the monocytic lineage. A further subclassification (M5a versus M5b) is made depending on whether the monocytic cells are predominantly monoblasts (>80%) (acute monoblastic leukemia) or a mixture of monoblasts and promonocytes (<80% blasts). Monoblasts can be distinguished by having a roughly circular nucleus, delicate lacy chromatin, and abundant, often basophilic cytoplasm. These cells may also have pseudopods. By contrast, promonocytes have a more convoluted nucleus, and their cytoplasm may contain metachromatic granules. Monoblasts are typically MPO-negative and promonocytes are MPO variable. Both monoblasts and promonocytes stain positive for non-specific esterase (NSE), however NSE may often be negative.

Immunophenotypically, M5-AML variably express myeloid (CD13, CD33) and monocytic (CD11b, CD11c) markers. Cells may aberrantly express B-cell marker CD20 and the NK marker CD56. Monoblasts may be positive for CD34.

Causes

M5 is associated with characteristic chromosomal abnormalities, often involving Chromosome 11 at 11q23 or t(9;11) affecting the MLL locus, however the MLL translocation is also found in other AML subtypes. MLL is believed to be prognostically unfavorable in AML-M5 compared to other genetic alterations involving MLL such as t(9;11). The t(8;16) translocation in MLL is associated with hemophagocytosis.

Secondary leukaemia, which may include AML-M5, has been associated with exposure to epipodophyllotoxins, such as etoposide.^[2]

Treatment

AML-M5 is treated with intensive chemotherapy (such as anthracyclines) or with bone marrow transplantation.

References

↑ "Acute Myeloid Leukemia - Signs and Symptoms".
↑ Kollmannsberger, C.; et al. (Oct 1998). "Secondary leukemia following high cumulative doses of etoposide in patients treated for advanced germ cell tumors.". J. Clin. Oncol. (16(10)): 3386–91.

External links

Diseases of red blood cells and clotting (D50–69,74, 280–287)

Red
blood cells

↑

Polycythemia	Polycythemia vera

↓

Anemia

Nutritional

Micro-: Iron-deficiency anemia
- Plummer–Vinson syndrome

Macro-: Megaloblastic anemia
- Pernicious anemia

Hemolytic
(mostly normo-)

Hereditary	enzymopathy: G6PD glycolysis PK TI HK hemoglobinopathy: Thalassemia alpha beta delta Sickle-cell disease/trait HPFH membrane: Hereditary spherocytosis Minkowski–Chauffard syndrome Hereditary elliptocytosis Southeast Asian ovalocytosis Hereditary stomatocytosis

Acquired	Autoimmune WAHA CAD PCH membrane PNH MAHA TM HUS Drug-induced autoimmune Drug-induced nonautoimmune Hemolytic disease of the newborn

Aplastic
(mostly normo-)

Blood tests

MCV
MCHC
- Normochromic
- Hypochromic

Other

Coagulation/
coagulopathy

↑

Hyper- coagulability	primary: Antithrombin III deficiency Protein C deficiency/Activated protein C resistance/Protein S deficiency/Factor V Leiden Prothrombin G20210A Sticky platelet syndrome acquired:Thrombocytosis essential DIC Purpura fulminans autoimmune Antiphospholipid

↓

Hypo-
coagulability

Thrombocytopenia	Thrombocytopenic purpura: ITP Evans syndrome TM TTP Upshaw Schulman syndrome Heparin-induced thrombocytopenia May–Hegglin anomaly

Platelet function	adhesion Bernard–Soulier syndrome aggregation Glanzmann's thrombasthenia platelet storage pool deficiency Hermansky–Pudlak syndrome Gray platelet syndrome

Clotting factor	Hemophilia A/VIII B/IX C/XI von Willebrand disease Hypoprothrombinemia/II XIII Dysfibrinogenemia Congenital afibrinogenemia

Myeloid hematological malignancy/leukemia histology (ICD-O 9590–9989, C81–C96, 200–208)

CFU-GM/
and other granulocytes

CFU-GM

Myelocyte

AML:	Acute myeloblastic leukemia M0 M1 M2 APL/M3

MP	Chronic neutrophilic leukemia

Monocyte

AML	AMoL/M5 Myeloid dendritic cell leukemia

CML	Philadelphia chromosome Accelerated phase chronic myelogenous leukemia

Myelomonocyte

AML	M4

MD-MP	Juvenile myelomonocytic leukemia Chronic myelomonocytic leukemia

Other

Histiocytosis

CFU-Baso

AML	Acute basophilic

CFU-Eos

AML	Acute eosinophilic

MP	Chronic eosinophilic leukemia/Hypereosinophilic syndrome

MEP

CFU-Meg

AML	AMKL/M7

MP	Essential thrombocytosis

CFU-E

AML	Erythroleukemia/M6

MP	Polycythemia vera

MD	Refractory anemia Refractory anemia with excess of blasts Chromosome 5q deletion syndrome Sideroblastic anemia Paroxysmal nocturnal hemoglobinuria Refractory cytopenia with multilineage dysplasia

CFU-Mast

Mastocytoma	Mast cell leukemia Mast cell sarcoma Systemic mastocytosis

Mastocytosis:	Diffuse cutaneous mastocytosis Erythrodermic mastocytosis Adult type of generalized eruption of cutaneous mastocytosis Urticaria pigmentosa Mast cell sarcoma Solitary mastocytoma

Systemic mastocytosis	Xanthelasmoidal mastocytosis

Multiple/unknown

AML	Acute panmyelosis with myelofibrosis Myeloid sarcoma

MP	Myelofibrosis Acute biphenotypic leukaemia

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