الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute myeloid leukemia is characterized by clonal myeloid precursor proliferation with decreased differentiation into more mature cells. It is not a single entity, but rather an umbrella diagnosis that comprises multiple subtypes with different prognostic and predictive features and can be treated effectively with selective and targeted therapies, which are still being optimized.
In Egypt, leukemia comprises 10% of all malignancies, with AML representing 16.9%. The incidence is approximately 1.03/100000/year with 1023 new AML cases in 2013.
Pathogenesis of AML is a complex multistep process that results from the interaction of two different classes of mutations. The first class of mutation impairs cell differentiation resulting in clonal expansion of myeloid progenitors. The second class causes abnormal cell proliferation by constitutive activation of cellular proto-oncogenes including FLT3 tyrosine kinase, RAS, c-KIT, and others.
The clinical presentation of acute leukemia results from infiltration of bone marrow or extramedullary sites by blasts. Symptoms are mostly due to complications of pancytopenia such as fatigue, recurrent infection, epistaxis, ecchymosis and bleeding tendency.
Diagnosis is by blood film, BMA and flow Cytometer, pretreatment cytogenetic abnormalities are the most powerful predictor of outcome.
Intensive induction therapy with “3+7” regimens results in CR which is achieved in 60% to 80% of younger adults and 40% to 60% of older adults (60 years or above). Patients with suspected acute promyelocytic leukemia (APL) should be treated with all-trans retinoic acid (ATRA) even before the diagnosis is confirmed.
Consolidation or post-induction therapy is given to prevent relapse and eradicate minimal residual leukemia (MRD) in the bone marrow after induction as a bridge to transplant or to achieve cure.
Patients with acute leukemia are highly susceptible to infectious diseases due to factors related to the disease itself, factors attributed to treatment, and specific individual risk factors in each patient.
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