Acute myeloid leukaemia : AML M0 with 11q deletion

Abstract

Acute myeloid leukaemia (AML) in the undifferentiated form can be a challenging. The prognosis of patients with AML- M0 is remarkably poor as compared to other WHO/FAB (French-American-British) subtypes. Conventional combination chemotherapy yields disappointing results. The reason for this may be the convergence of various unfavourable prognostic factors such as the high incidence of cytogenetic abnormalities, lack of differentiation features and the expression of immature markers such as CD34 and CD7 and the frequent expression of P-170 [1]. There are reports of a high frequency of mutations of AML1 gene in AML M0. Patients with AML1 mutations showed significantly higher leucocyte counts and higher marrow blast percentage, suggesting that this mutation is associated with greater cell proliferation, higher incidence of HLA-DR expression and higher frequency of IgH or T cell receptor (TCR) gene rearrangement [2]. Although many cases of acute myeloid leukaemias can be correctly identified morphologically with or without enzyme cytochemical analysis, immunophenotyping remains indispensable for proper identification of myeloid lineage in AML M0 [3]. We present a case of AML to highlight the problems encountered in diagnosis and management.