Signs and symptoms of acute leukemias are related to the infiltration of leukemic cells into normal tissues, resulting in either bone marrow failure (anemia, neutropenia, thrombocytopenia) or specific tissue infiltration (lymph nodes, liver, spleen, brain, bone, skin, gingiva, testes). Common presenting symptoms are fever, pallor, petechiae or ecchymoses, lethargy, malaise, anorexia, and bone or joint pain. Physical examination frequently reveals lymphadenopathy and hepatosplenomegaly. The testes and central nervous system (CNS) are common extramedullary sites for ALL; neurologic symptoms or a painless enlargement of one or both testes may be seen. Patients with T-cell ALL often have high white blood cell (WBC) counts, anterior mediastinal masses, bulky disease
ALL, B cell—L3 morphology (i.e., Burkitt leukemia)
AMLs with recurrent cytogenetic translocations AML with t(8;21)(q22; q22), AML1(CBF-alpha)/ETO Acute promyelocytic leukemia—AML with t(15;17)(q22; q11–12) and variants, PML/RAR-alpha) (i.e., M3*)
AML with abnormal bone marrow eosinophils—inv(16) (p13q22) or t(16;16)(p13; q11), CBFb/MYH11 AML with 11q23/MLL abnormalities
AML with multilineage dysplasia With prior myelodysplastic syndrome Without prior myelodysplastic syndrome
AML and myelodysplastic syndromes, therapy-related Alkylating agent-related Epipodophyllotoxin-related (some may be lymphoid) Other types
AML not otherwise categorized AML minimally differentiated (M1) AML without maturation (M0) AML with maturation (M2) Acute myelomonocytic leukemia (M4) Acute monocytic leukemia (M5) Acute erythroid leukemia (M6) Acute megakaryocytic leukemia (M7) Acute basophilic leukemia Acute panmyelosis with myelofibrosis
Modified from World Health Organization Classification. MLL, Mixed lineage leukemia. *The designations M0 to M7 are those of the French-AmericanBritish classification system for AML, which predated the World Health Organization system and is still used by many clinicians and pathologists.
with cervical lymphadenopathy, hepatosplenomegaly, and CNS involvement. In patients with AML, extramedullary softtissue tumors may be found in various sites.