Hematologic Malignancies USMLE Step 1 Practice Question

A 32-year-old man presents to the emergency department with a 2-week history of progressive fatigue, petechiae, and left upper quadrant abdominal pain. He denies fever, night sweats, or recent infections. Vital signs: BP 128/82 mmHg, HR 102/min, RR 20/min, temperature 37.8°C, SpO2 98% on room air. Physical examination reveals splenomegaly and diffuse petechiae. Laboratory studies: WBC 120,000/μL, hemoglobin 7.2 g/dL, platelets 30,000/μL, LDH 2800 U/L, uric acid 9.2 mg/dL, creatinine 1.0 mg/dL. Peripheral blood smear shows 80% blasts with abundant cytoplasm and Auer rods. Flow cytometry demonstrates: CD13+, CD33+, CD117+, MPO+, CD34+, HLA-DR+. Cytogenetic analysis reveals t(8;21)(q22;q22). Which of the following is the most likely diagnosis?