What are the symptoms of acute myeloblastic leukemia with maturation (AML-M2)?

Symptoms of Acute Myeloblastic Leukemia with Maturation (AML-M2)

AML-M2 presents with symptoms resulting from bone marrow failure and organ infiltration, most commonly including fatigue, bleeding manifestations, fever, and infections. 1

Primary Symptoms from Bone Marrow Failure

Fatigue and weakness are among the most common presenting complaints, resulting from anemia secondary to bone marrow failure. 1 Patients may also experience:

• Dyspnea and dizziness related to anemia 1
• Lethargy as a prominent constitutional symptom 1

Bleeding and bruising occur frequently due to thrombocytopenia and/or platelet dysfunction. 1 This manifests as:

• Easy bruising 1
• Bleeding episodes 1
• Coagulopathy, which is common at presentation and should be screened before any invasive procedures 2

Fever and recurrent infections develop from neutropenia and leukocyte dysfunction. 1 These infectious complications are a major presenting feature requiring immediate attention. 1

Constitutional Symptoms

Patients commonly present with systemic symptoms including:

• Night sweats 1
• Unintentional weight loss 1
• Fever (which may occur independent of infection) 1

Severe fatigue reported before treatment has independent prognostic value and associates with decreased survival, making careful evaluation of this symptom particularly important. 1

Physical Examination Findings

Approximately 20% of AML patients present with lymphadenopathy. 1 Less common physical findings include:

• Splenomegaly 1
• Hepatomegaly 1

These organomegaly findings are less frequent in AML compared to other hematologic malignancies but should be assessed on physical examination. 1

Clinical Presentation Patterns

AML typically presents with rapid onset of symptoms that may be fatal within weeks or months when left untreated. 3 The disease is characterized by:

• High levels of immature malignant cells 3
• Fewer differentiated red blood cells, platelets, and white blood cells 3
• Abnormal differentiation of myeloid cells 3

Important Clinical Considerations

Coagulopathy should be evaluated by checking prothrombin time, partial thromboplastin time, and fibrinogen activity as part of initial evaluation. 2 This is standard clinical practice before performing any invasive procedures. 2

Cardiac evaluation should be determined based on individual risk factors, including history or symptoms of cardiac disease, prior exposure to cardiotoxic drugs, or older age. 2 An echocardiogram is recommended for these patients, though in acutely ill patients, treatment should not be delayed for cardiac imaging. 2