Two Onc Docs Acute Myeloid Leukemia (AML) 2024 x Dr. Catherine Lai Part 1
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Jun 19, 2024 Dr. Catherine Lai discusses AML classification, genetic mutations, and risk factors. Topics include treatment-related factors, hereditary myeloid malignancies, and managing leukostasis and tumor lysis syndrome in leukemia.
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Typical Presentation And Leukostasis Signs
- AML usually presents with fatigue, bruising, or bleeding from pancytopenia and sometimes leukocytosis symptoms.
- Leukostasis symptoms (shortness of breath, stroke-like signs, chest pain) depend on clinical context, not just white count.
Flag Prior Cancer Therapy As A Risk
- Consider any prior chemotherapy, radiation, or immunosuppressive therapy as treatment-related AML regardless of exact timing.
- Watch for anthracyclines/Topo II exposure and radiation or alkylating agents that classically link to specific cytogenetic changes.
When To Suspect Germline Mutations
- Hereditary myeloid predisposition genes (e.g., DDX41, RUNX1) are being found more often via NGS panels.
- A VAF around 40–60% in a young patient raises suspicion for germline mutation and prompts confirmatory testing.