The Indian Council of Medical Research (ICMR) has issued draft consensus document for management of acute myeloid leukaemia (AML) to assist the doctors in making major clinical decisions encountered in managing their patients.
The consensus document provides details to the doctors about AML and its diagnosis, treatment, consolidation therapy in AML, management of elderly AML, prognostic factors in AML, guideline for management of acute promyelocytic leukaemia, treatment of granulocytic sarcoma, down syndrome & acute myeloid leukaemia and treatment of secondary acute myeloid leukaemia.
The initiative of the ICMR in this regard is significant as cases of AML are increasing in the country.
AML is characterized by clonal neoplastic proliferation of myeloid precursor cells in the marrow and arrest of their maturation. The replacement of marrow by leukaemic cells (blasts) leads to clinical features characterized by anaemia, thrombocytopenia and granulocytopenia with or without leukocytosis. The resultant accumulation of these non-functional blast cells prevents normal haematopoiesis, which if untreated will result in bone marrow failure and the death of the affected individual. Its annual incidence is 2-3 per 100,000. Incidence increases with age. It is less than 1per 100,000 under 30 years of age and 17 per 100,000 by 75 years. AML accounts for less than 10% of all leukaemia’s in children less than 10 years of age, and for 25-30% between 10 and 15 years. In adults, AML accounts for 80-90% of cases of acute leukaemia. The incidence is higher in males than in females. As per Delhi population based cancer registry AML constitutes about 3 per cent of all cancers with a median age of 32 years.
According to the document, symptoms of AML are results of bone marrow failure, tissue infiltration by leukaemic cells or may be due to circulating leukaemic cells. Patient usually presents with fatigue and abnormal bleeding. Weight loss, fever, night sweats may be present. Bone pain and testicular enlargement are due to extra medullary involvement by the leukaemic cells. Patient may have headache, vomiting, blurring of vision due to central nervous system involvement. On physical examination, pallor and features of thrombocytopenia like epistaxis, gingival bleed, petechial, ecchymotoic patches may be obvious findings. Patient may have organomegalyhepatosplenomegaly, Lymphadenopathy and gingival hypertrophy (usually in myelomonocytic and monocytic leukaemia or acute promyelocytic leukaemia). Rare features are skin involvement and arthritis.
ICMR has now asked the stakeholders to send their suggestions and comments to the Council by April 11, 2018.