Questions about acute megakaroblastic leukemia...?

Questions about acute megakaroblastic leukemia...?
1. Is AML chemorisistant like acute promyelocytic leukemia? I think I remember reading somewhere that it is, but I'm not sure.

2. According to Wikipedia, pancytopenia (the reduction of red and white blood cells as well as platelets) was a side-effect of AML. Now, in most leukemia patients, pancytopenia is caused by chemo, not the disease itself. Could someone please explain the relationship between AML and pancytopenia to me in more detail?

Thanks in advance!
-Elly :-)

- Spreedog
Be careful with the term AML for this. "AML" usually refers to Acute Myelogenous leukemia also known as Acute Myeloblastic or Myelocytic Leukemia for which there are at least 7 types. Acute megakaryoblastic leukemia (AMKL) is classified as "M7" type in the FAB (French-American-British) classification. You can get a simple review via Wiki - which you have already done. http://en.wikipedia.org/wiki/Acute_megakaryoblastic_leukemia

Acute Promyelocytic Leukemias (FAB M3 type) are responding very well to treatment today. From http://asheducationbook.hematologylibrary.org/cgi/content/full/2006/1/147 "Cure of acute promyelocytic leukemia (APL) is now a possibility for most patients through the use of state-of-the-art treatments, which include simultaneous administration of all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy for induction and consolidation, as well as ATRA-based maintenance."
Also - http://www.cancer.org/docroot/CRI/content/CRI_2_4_4x_Treatment_of_Acute_Promyelocytic_M3_Leukemia_AML.asp

Pancytopenia is a common presentation of AMKL rather than a side effect. The reason is that there is often fibrosis in the marrow space. The marrow is often "packed" with large numbers of blasts such that the production of normal red cells, white cells, and platelets is severely impeded. We see this in some cases of other AML subtypes and call this aleukemic leukemia because there is not a high white cell count in the peripheral blood. There are variations in responsiveness from one case of AMKL to another since each case has different chromosomal abnormalities, levels of fibrosis, and other characteristics which we do not completely understand at this time. Responses in all types of AML depend on a complex array of factors not all of which have been completely identified. We still have much to learn, but the bottom line is that no two patients are identical with any type or subtype of malignancy - including the many leukemias.

"MDgreg" I would expect to see reduced platelets, aberrant platelet morphology, and RBC poikilocytosis (with an elevated automated RDW) on a personal peripheral blood smear examination - which is the only way a real hematologist should evaluate someone with a blood disorder. Does anyone look at blood smears anymore? We never charged for this and it is time consuming, so maybe it's not "cost effective."

- mdGreg C
Hey Spreed, Are Platelets In PB Reduced as Well? Sounds Like they Are.


EDIT: Would One Expect to See a Poikilocytosis On a PB Smear? Elevated RDW? Anemia of Chronic Disease?


EDIT: Sorry Spreed, Destruction Anemia. Too Bad Simple Things Aren't Done Anymore By Real Doctors.

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