Oxford Textbook of Medicine (5 edn)
Contents
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Epidemiology and causation Epidemiology and causation
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Diagnosis Diagnosis
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Prognostic factors Prognostic factors
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Treatment of AML Treatment of AML
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General considerations General considerations
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Definition of remission Definition of remission
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Chemotherapeutic regimens Chemotherapeutic regimens
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Outcomes of treatment Outcomes of treatment
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Indications for further chemotherapy Indications for further chemotherapy
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Consolidation of chemotherapy Consolidation of chemotherapy
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Treatment of older patients Treatment of older patients
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Treatment of relapsed AML Treatment of relapsed AML
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Targeted therapy Targeted therapy
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Maintenance chemotherapy and DNA methylation Maintenance chemotherapy and DNA methylation
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Bone marrow transplantation Bone marrow transplantation
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Supportive care in AML Supportive care in AML
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Supportive care at the initiation of therapy Supportive care at the initiation of therapy
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Hyperleucocytosis Hyperleucocytosis
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Tumour lysis syndrome and metabolic complications Tumour lysis syndrome and metabolic complications
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Other supportive measures prior to starting cytotoxic therapy Other supportive measures prior to starting cytotoxic therapy
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Supportive care during chemotherapy-induced pancytopenia Supportive care during chemotherapy-induced pancytopenia
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Blood product support Blood product support
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Infection Infection
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Acute promyelocytic leukaemia Acute promyelocytic leukaemia
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Treatment of APL Treatment of APL
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Supportive care issues specific to treatment initiation in APL Supportive care issues specific to treatment initiation in APL
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Complications of treatment in APL Complications of treatment in APL
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Further reading Further reading
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Cite
Extract
Essentials
Epidemiology and causation
The median age at presentation is 68 years. Acute myeloid leukaemia (AML) occurs at all ages, ranging in frequency from 3 per million up to 12 to 15 per million patients in their 70s and 80s (Fig. 22.3.4.1). This age range has implications for treatment. In most cases there is no obvious cause; however, it is known that chemical and ionizing radiation exposure can be leukaemogenic. Several diseases of older patients evolve from the related disorder myelodysplastic syndrome, and indeed the boundary between the diseases is sometimes hard to define. The current international consensus defines AML as over 20% blast cells in the bone marrow. At this level, marrow function is usually compromised requiring intervention. An increasing risk of chemotherapy in general is that it may be leukaemogenic, and the development of AML represents a late complication of treatment of solid tumours, which is becoming more often seen as chemotherapy becomes more successful.
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