Initial management
Identifying the 5 main life threatening situations associated with AML
- Tumor lysis: IV fluids, allopurinol, test for G6PD def, rasburicase
- DIC: fibrinogen > 150 using cryo
- Neutropenic sepsis: CXR, UA, broad spectrum antibiotics
- Bleeding: pRBC, plt leukoreduced, irradiated ( if transplant eligible)
- Hyperleukocytosis: hydroxyurea
Additional work up on admission: Echo, triple lumen, HLA typing of patient, bone marrow bx, skin bx.
20% blast count is no longer required for diagnosis of AML with recurrent genetic abnormalities except biallelic CEBPA mutation.
Risk stratification
ELN 2022 for standard therapy in younger individuals
ELN 2024 for lower intensity rx such as AZA- Ven.
- TP53 mutated--> poor
- KRAS, NRAS, LFT 3 ITD without TP53--> intermediate
- All others - beneficial
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