Acute Myeloid Leukemia vs Acute Lymphoblastic Leukemia
Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Acute Myeloid Leukemia vs Acute Lymphoblastic Leukemia at a glance
- Acute Myeloid Leukemia: Clonal expansion of myeloid blasts in marrow and blood — pancytopenia plus circulating blasts; APL subtype is a hemorrhagic emergency.
- Acute Lymphoblastic Leukemia: Clonal expansion of lymphoid blasts — most common pediatric cancer; CNS sanctuary and Philadelphia chromosome subtype distinctive.
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Side-by-side comparison
| Feature | Acute Myeloid Leukemia | Acute Lymphoblastic Leukemia |
|---|---|---|
| At a glance | Clonal expansion of myeloid blasts in marrow and blood — pancytopenia plus circulating blasts; APL subtype is a hemorrhagic emergency. | Clonal expansion of lymphoid blasts — most common pediatric cancer; CNS sanctuary and Philadelphia chromosome subtype distinctive. |
| Classic presentation | Older adult with pancytopenia, fatigue, petechiae, and Auer rods on blast smear. APL: severe DIC with intracranial or pulmonary hemorrhage at presentation.; Pancytopenia symptoms: fatigue, dyspnea, pallor (anemia); easy bruising, petechiae, mucosal bleeding (thrombocytopenia); fever, recurrent infections (neutropenia); Constitutional:… | Child 2-5 years old with bone pain, refusal to walk, pallor, petechiae, hepatosplenomegaly, and circulating lymphoblasts.; Pancytopenia symptoms: fatigue, pallor, dyspnea (anemia); easy bruising, petechiae, epistaxis (thrombocytopenia); fever, infection (neutropenia); Constitutional: fever, night sweats, weight loss, malaise; BONE PAIN… |
| Workup / key labs | ≥20% myeloid blasts in bone marrow or peripheral blood (WHO 5th edition); or any blast percentage with recurrent cytogenetic abnormality t(15;17), t(8;21), inv(16)/t(16;16). APL diagnosed by t(15;17) PML-RARA or PML-RARA fusion.; CBC — anemia, thrombocytopenia; WBC may be high, normal, or low; circulating blasts often visible;… | ≥20% lymphoblasts in bone marrow or peripheral blood with lymphoid immunophenotype (B-cell or T-cell precursor markers, TdT positive) — distinct from mature B-cell neoplasms (Burkitt) which lack TdT.; CBC — anemia, thrombocytopenia; WBC variable (high, normal, or low); lymphoblasts on smear; Peripheral smear — lymphoblasts (small to… |
| Imaging | CXR if pulmonary symptoms; chest CT for febrile neutropenia evaluation; Echocardiogram before anthracycline therapy; CT or MRI head if neurologic symptoms | Chest X-ray and CT chest — mediastinal mass especially in T-ALL (do BEFORE sedation/anesthesia to assess airway compression risk); Testicular ultrasound if suspected involvement; MRI brain/spine for symptomatic CNS disease |
| First-line treatment | Induction chemotherapy '7+3': cytarabine (continuous infusion × 7 days) + anthracycline (daunorubicin or idarubicin × 3 days) — standard for fit patients; Addition of midostaurin for FLT3-mutated AML (RATIFY trial); gilteritinib for FLT3-mutated relapsed/refractory; Older or unfit patients: venetoclax (BCL-2 inhibitor) + hypomethylating… | Induction (4 weeks): vincristine + corticosteroid (prednisone/dexamethasone) + anthracycline (daunorubicin) + asparaginase (PEG-asparaginase or Erwinia); achieves remission in >95% of pediatric ALL, ~80% of adult ALL; Consolidation/intensification: cyclophosphamide, cytarabine, mercaptopurine, methotrexate; CNS prophylaxis: intrathecal… |
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