Differential Diagnosis for AML vs ALL When differentiating between Acute Monocytic Leukemia (AML) and Acute Unstable Leukemia (ALL), several key factors and diagnoses must be considered. The following differential diagnosis is organized into categories to guide the diagnostic process.
Single most likely diagnosis
- AML: This is often considered the single most likely diagnosis in adults presenting with acute leukemia due to its higher incidence in this population. AML is characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and other parts of the body.
- ALL: In children and young adults, ALL is more common and thus might be considered the single most likely diagnosis in these age groups. ALL involves the growth of immature lymphocytes, which can lead to bone marrow failure.
Other Likely diagnoses
- Acute Myeloid Leukemia with Maturation (M2): This subtype of AML is characterized by the presence of mature neutrophils and their precursors, which can sometimes make differentiation from ALL challenging.
- B-Cell Acute Lymphoblastic Leukemia: This is the most common type of ALL and is distinguished by the presence of B-cell markers on the surface of the leukemic cells.
- T-Cell Acute Lymphoblastic Leukemia: Although less common than B-cell ALL, T-cell ALL is another consideration, especially in children and young adults, and is characterized by the presence of T-cell markers.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute Promyelocytic Leukemia (APL): A subtype of AML characterized by the accumulation of promyelocytes in the bone marrow. It is crucial to diagnose APL promptly because it can lead to severe bleeding due to disseminated intravascular coagulation (DIC) if not treated immediately with all-trans retinoic acid (ATRA) and other supportive measures.
- Burkitt Lymphoma/Leukemia: Although rare, this condition can present similarly to ALL but requires different and urgent treatment due to its aggressive nature and potential for rapid progression.
Rare diagnoses
- Acute Monoblastic and Monocytic Leukemia: A rare subtype of AML that involves the proliferation of monoblasts and monocytic cells.
- Mixed-Category Leukarmia: This includes conditions like mixed-type acute leukemia, where both myeloid and lymphoid markers are present, making classification and treatment challenging.
- Natural Killer (NK) Cell Leukemia: A rare and aggressive form of leukemia that originates from NK cells, requiring prompt and specific treatment approaches.