Acute lymphoblastic leukemia classification: Difference between revisions

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Latest revision as of 20:29, 8 April 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Carlos A Lopez, M.D. [3]

Overview

Acute lymphoblastic leukemia may be classified according to either the French-American-British (FAB) classification or World Health Organization (WHO) classification scheme. According to the French-American-British (FAB) classification, acute lymphoblastic leukemia may be classified into 3 subgroups: ALL-L1 (small uniform cells), ALL-L2 (large varied cells) and ALL-L3 (large varied cells with vacuoles). According to the World Health Organization (WHO), acute lymphoblastic leukemia may also be classified into 3 subgroups: B lymphoblastic leukemia/lymphoma, B lymphoblastic leukemia/lymphoma (not organ specific), and B lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities.

Classification

Acute lymphoblastic leukemia may be classified according to either the French-American-British (FAB) classification system or the World Health Organization (WHO) classification system:

French-American-British Classification System

According to the French-American-British classification system, acute lymphoblastic leukemia is classified into 3 subgroups based on the cellular origin of the disease, cellular maturity, and morphology:^[1]^[2]

ALL-L1: small uniform cells
ALL-L2: large varied cells
ALL-L3: large varied cells with vacuoles (bubble-like features)

Each subtype is further classified based on immunophenotyping (the presence of surface markers of the abnormal lymphocytes). There are 2 main immunologic types:

Pre-B cell^[3]
Pre-T cell^[4]

The mature B-cell acute lymphoblastic leukemia (L3) is called Burkitt leukemia/lymphoma.

World Health Organization Classification System

The World Health Organization (WHO) classification of acute lymphoblastic leukemia is based on the prognosis of the disease. According to the WHO classification system, acute lymphoblastic leukemia may be classified into 3 subgroups:^[5]^[6]^[7]

Group 1

B lymphoblastic leukemia/lymphoma

Group 2

B lymphoblastic leukemia/lymphoma (Not organ specific)

Group 3

B lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities:

B lymphoblastic leukemia/lymphoma with t(9;22)(q34;q11.2), BCR-ABL1
B lymphoblastic leukemia/lymphoma with t(v;11q23); MLL rearranged
B lymphoblastic leukemia/lymphoma with t(12;21)(p13;q22) TEL-AML1 (ETV6-RUNX1)
B lymphoblastic leukemia/lymphoma with hyperdiploidy
B lymphoblastic leukemia/lymphoma with hypodiploidy
B lymphoblastic leukemia/lymphoma with t(5;14)(q31;q32) IL3-IGH
B lymphoblastic leukemia/lymphoma with t(1;19)(q23;p13.3) TCF3-PBX1

Acute lymphoblastic leukemia -L1: Small uniform cells subtype.
^{Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan}

Acute lymphoblastic leukemia-L1: Large varied cells subtype.
^{Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan}

Acute lymphoblastic leukemia-L2: Large varied cells (Hand mirror cell).
^{Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan}

Acute lymphoblastic leukemia-L2: Large varied cells.
^{Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan}

Acute lymphoblastic leukemia-L3: Large varied cells with vacuoles (bubble-like features.
^{Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan}

References

↑ van Eys J, Pullen J, Head D, Boyett J, Crist W, Falletta J, Humphrey GB, Jackson J, Riccardi V, Brock B (March 1986). "The French-American-British (FAB) classification of leukemia. The Pediatric Oncology Group experience with lymphocytic leukemia". Cancer. 57 (5): 1046–51. PMID 3484662.
↑ Lilleyman JS, Hann IM, Stevens RF, Eden OB, Richards SM (September 1986). "French American British (FAB) morphological classification of childhood lymphoblastic leukaemia and its clinical importance". J. Clin. Pathol. 39 (9): 998–1002. PMC 500200. PMID 3463568.
↑ Nahar R, Müschen M (2009). "Pre-B cell receptor signaling in acute lymphoblastic leukemia". Cell Cycle. 8 (23): 3874–7. doi:10.4161/cc.8.23.10035. PMC 4047560. PMID 19901533.
↑ Han X, Bueso-Ramos CE (2007). "Precursor T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma and acute biphenotypic leukemias". Am J Clin Pathol. 127 (4): 528–44. doi:10.1309/2QE3A6EKQ8UYDYRC. PMID 17369128.
↑ Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES (2011). "The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications". Blood. 117 (19): 5019–32. doi:10.1182/blood-2011-01-293050. PMC 3109529. PMID 21300984.
↑ Chiaretti S, Zini G, Bassan R (2014). "Diagnosis and subclassification of acute lymphoblastic leukemia". Mediterr J Hematol Infect Dis. 6 (1): e2014073. doi:10.4084/MJHID.2014.073. PMC 4235437. PMID 25408859.
↑ Kebriaei P, Anastasi J, Larson RA (December 2002). "Acute lymphoblastic leukaemia: diagnosis and classification". Best Pract Res Clin Haematol. 15 (4): 597–621. PMID 12617866.

Template:WH Template:WS

[pmid3484662-1] van Eys J, Pullen J, Head D, Boyett J, Crist W, Falletta J, Humphrey GB, Jackson J, Riccardi V, Brock B (March 1986). "The French-American-British (FAB) classification of leukemia. The Pediatric Oncology Group experience with lymphocytic leukemia". Cancer. 57 (5): 1046–51. PMID 3484662.

[pmid3463568-2] Lilleyman JS, Hann IM, Stevens RF, Eden OB, Richards SM (September 1986). "French American British (FAB) morphological classification of childhood lymphoblastic leukaemia and its clinical importance". J. Clin. Pathol. 39 (9): 998–1002. PMC 500200. PMID 3463568.

[pmid19901533-3] Nahar R, Müschen M (2009). "Pre-B cell receptor signaling in acute lymphoblastic leukemia". Cell Cycle. 8 (23): 3874–7. doi:10.4161/cc.8.23.10035. PMC 4047560. PMID 19901533.

[pmid17369128-4] Han X, Bueso-Ramos CE (2007). "Precursor T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma and acute biphenotypic leukemias". Am J Clin Pathol. 127 (4): 528–44. doi:10.1309/2QE3A6EKQ8UYDYRC. PMID 17369128.

[pmid21300984-5] Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES (2011). "The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications". Blood. 117 (19): 5019–32. doi:10.1182/blood-2011-01-293050. PMC 3109529. PMID 21300984.

[pmid25408859-6] Chiaretti S, Zini G, Bassan R (2014). "Diagnosis and subclassification of acute lymphoblastic leukemia". Mediterr J Hematol Infect Dis. 6 (1): e2014073. doi:10.4084/MJHID.2014.073. PMC 4235437. PMID 25408859.

[pmid12617866-7] Kebriaei P, Anastasi J, Larson RA (December 2002). "Acute lymphoblastic leukaemia: diagnosis and classification". Best Pract Res Clin Haematol. 15 (4): 597–621. PMID 12617866.

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[2]

[3]

[4]

[5]

[6]

[7]

@@ Line 4: / Line 4: @@
 {{CMG}} {{AE}} {{RT}} {{CLG}}
 == Overview ==
-Acute lymphoblastic leukemia may be classified according to the [[French-American-British classification | French-American-British (FAB) classification]] and [[World Health Organization]] (WHO). The [[French-American-British classification | French-American-British (FAB) classification]] is divided into 3 groups:  ALL-L1: small uniform cells, ALL-L2: large varied cells, ALL-L3: large varied cells with [[vacuole]]s (bubble-like features). [[World Health Organization]] (WHO) classification is divided into 3 groups: B lymphoblastic leukemia/lymphoma, B lymphoblastic leukemia/lymphoma (Not organ specific), B lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities.
+Acute lymphoblastic leukemia may be classified according to either the [[French-American-British classification | French-American-British (FAB) classification]] or [[World Health Organization]] (WHO) classification scheme. According to the [[French-American-British classification | French-American-British (FAB) classification]], acute lymphoblastic leukemia may be classified into 3 subgroups:  ALL-L1 (small uniform cells), ALL-L2 (large varied cells) and ALL-L3 (large varied cells with [[vacuole]]s). According to the [[World Health Organization]] (WHO), acute lymphoblastic leukemia may also be classified into 3 subgroups: B lymphoblastic leukemia/lymphoma, B lymphoblastic leukemia/lymphoma (not organ specific), and B lymphoblastic leukemia/lymphoma with recurrent [[Genetics|genetic]] abnormalities.
 == Classification ==
-There are 2 classifications systems for acute lymphoblastic leukemia, the [[French-American-British classification | French-American-British (FAB) classification]] and the [[World Health Organization]] (WHO):
+Acute lymphoblastic leukemia may be classified according to either the [[French-American-British classification | French-American-British (FAB)]] classification system or the [[World Health Organization]] (WHO) classification system:
-===French-American-British classification===
+===French-American-British Classification System===
-The [[French-American-British classification | French-American-British (FAB) classification]] of acute lymphoblastic leukemia is divided into 3 subtypes L1 to L3 based on the type of cell from which the leukemia developed and its degree of maturity and morphological classification. Each subtype is then further classified by determining the surface markers of the abnormal lymphocytes, called immunophenotyping. There are 2 main immunologic types: pre-B cell and pre-T cell. The mature B-cell acute lymphoblastic leukemia (L3) is now classified as Burkitt leukemia/lymphoma.
+According to the French-American-British classification system, acute lymphoblastic leukemia is classified into 3 subgroups based on the [[cellular]] origin of the disease, [[cellular]] maturity, and [[morphology]]:<ref name="pmid3484662">{{cite journal |vauthors=van Eys J, Pullen J, Head D, Boyett J, Crist W, Falletta J, Humphrey GB, Jackson J, Riccardi V, Brock B |title=The French-American-British (FAB) classification of leukemia. The Pediatric Oncology Group experience with lymphocytic leukemia |journal=Cancer |volume=57 |issue=5 |pages=1046–51 |date=March 1986 |pmid=3484662 |doi= |url=}}</ref><ref name="pmid3463568">{{cite journal |vauthors=Lilleyman JS, Hann IM, Stevens RF, Eden OB, Richards SM |title=French American British (FAB) morphological classification of childhood lymphoblastic leukaemia and its clinical importance |journal=J. Clin. Pathol. |volume=39 |issue=9 |pages=998–1002 |date=September 1986 |pmid=3463568 |pmc=500200 |doi= |url=}}</ref>
+* ALL-L1: small uniform [[Cells (biology)|cells]]
+* ALL-L2: large varied [[Cells (biology)|cells]]
+* ALL-L3: large varied [[cells]] with [[vacuole]]s (bubble-like features)
-===Classification===
+Each subtype is further classified based on [[immunophenotyping]] (the presence of surface markers of the abnormal [[lymphocytes]]). There are 2 main immunologic types:
-* ALL-L1: small uniform cells
+*Pre-B cell<ref name="pmid19901533">{{cite journal| author=Nahar R, Müschen M| title=Pre-B cell receptor signaling in acute lymphoblastic leukemia. | journal=Cell Cycle | year= 2009 | volume= 8 | issue= 23 | pages= 3874-7 | pmid=19901533 | doi=10.4161/cc.8.23.10035 | pmc=4047560 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19901533  }} </ref>
-* ALL-L2: large varied cells
+*Pre-T cell<ref name="pmid17369128">{{cite journal| author=Han X, Bueso-Ramos CE| title=Precursor T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma and acute biphenotypic leukemias. | journal=Am J Clin Pathol | year= 2007 | volume= 127 | issue= 4 | pages= 528-44 | pmid=17369128 | doi=10.1309/2QE3A6EKQ8UYDYRC | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17369128  }} </ref>
-* ALL-L3: large varied cells with [[vacuole]]s (bubble-like features)
-===World Health Organization classification ===
+The mature [[B-cell]] acute lymphoblastic leukemia (L3) is called [[Burkitt lymphoma|Burkitt leukemia/lymphoma]].
-The [[World Health Organization]] (WHO) classification of acute lymphoblastic leukemia attempts to be more clinically useful and to produce more meaningful prognostic information than the [[French-American-British classification | French-American-British (FAB) classification]] criteria. There are 3 different grups of Lymphoblastic leukemias according to the WHO including a classification with recurrent genetic abnormalities.<ref name="pmid21300984">{{cite journal| author=Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES| title=The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. | journal=Blood | year= 2011 | volume= 117 | issue= 19 | pages= 5019-32 | pmid=21300984 | doi=10.1182/blood-2011-01-293050 | pmc=PMC3109529 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21300984  }} </ref>
+===World Health Organization Classification System ===
+The [[World Health Organization]] (WHO) classification of acute lymphoblastic leukemia is based on the [[prognosis]] of the disease. According to the WHO classification system, acute lymphoblastic leukemia may be classified into 3 subgroups:<ref name="pmid21300984">{{cite journal| author=Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES| title=The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. | journal=Blood | year= 2011 | volume= 117 | issue= 19 | pages= 5019-32 | pmid=21300984 | doi=10.1182/blood-2011-01-293050 | pmc=PMC3109529 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21300984  }} </ref><ref name="pmid25408859">{{cite journal |vauthors=Chiaretti S, Zini G, Bassan R |title=Diagnosis and subclassification of acute lymphoblastic leukemia |journal=Mediterr J Hematol Infect Dis |volume=6 |issue=1 |pages=e2014073 |date=2014 |pmid=25408859 |pmc=4235437 |doi=10.4084/MJHID.2014.073 |url=}}</ref><ref name="pmid12617866">{{cite journal |vauthors=Kebriaei P, Anastasi J, Larson RA |title=Acute lymphoblastic leukaemia: diagnosis and classification |journal=Best Pract Res Clin Haematol |volume=15 |issue=4 |pages=597–621 |date=December 2002 |pmid=12617866 |doi= |url=}}</ref>
 ===Group 1===
@@ Line 28: / Line 32: @@
 *B lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities:
-:*B lymphoblastic leukemia/lymphoma with t(9;22)(q34;q11.2), ''BCR-ABL1''
+:*B lymphoblastic leukemia/lymphoma with [[Philadelphia chromosome|t(9;22)(q34;q11.2)]], ''[[BCR/ABL|BCR-ABL1]]''
-:*B lymphoblastic leukemia/lymphoma with t(v;11q23); MLL rearranged
+:*B lymphoblastic leukemia/lymphoma with t(v;11q23); [[MLL (gene)|MLL]] rearranged
 :*B lymphoblastic leukemia/lymphoma with t(12;21)(p13;q22) ''TEL-AML1'' (ETV6-RUNX1)
 :*B lymphoblastic leukemia/lymphoma with hyperdiploidy
@@ Line 35: / Line 39: @@
 :*B lymphoblastic leukemia/lymphoma with t(5;14)(q31;q32) ''IL3-IGH''
 :*B lymphoblastic leukemia/lymphoma with t(1;19)(q23;p13.3) ''TCF3-PBX1''
-(Images shown below are courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan)
 {| align="center"
-|-valign="top"
+|- valign="top"
-| [[Image:ALL-L1.jpg|thumb|Acute lymphoblastic leukemia -L1: Small uniform cells subtype]]
+| [[Image:ALL-L1.jpg|thumb|Acute lymphoblastic leukemia -L1: Small uniform cells subtype.<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
-| [[Image:ALL-L1 0002.jpg|thumb|Acute lymphoblastic leukemia-L1: Large varied cells subtype]]
+| [[Image:ALL-L1 0002.jpg|thumb|Acute lymphoblastic leukemia-L1: Large varied cells subtype.<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
 |}
 {| align="center"
-|-valign="top"
+|- valign="top"
-| [[Image:ALL-L2 Hand mirror cell 0001.jpg|thumb|Acute lymphoblastic leukemia-L2: Large varied cells (Hand mirror cell)]]
+| [[Image:ALL-L2 Hand mirror cell 0001.jpg|thumb|Acute lymphoblastic leukemia-L2: Large varied cells (Hand mirror cell).<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
-| [[Image:ALL-L2 0003.jpg|thumb|Acute lymphoblastic leukemia-L2: Large varied cells]]
+| [[Image:ALL-L2 0003.jpg|thumb|Acute lymphoblastic leukemia-L2: Large varied cells.<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
 |}
 {| align="center"
-|-valign="top"
+|- valign="top"
-| [[Image:ALL-L2 0002.jpg|thumb|Acute lymphoblastic leukemia-L2: Large varied cells]]
+| [[Image:ALL-L2 0002.jpg|thumb|Acute lymphoblastic leukemia-L2: Large varied cells.<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
-| [[Image:ALL-L3 0001.jpg|thumb|Acute lymphoblastic leukemia-L3: Large varied cells with vacuoles (bubble-like features]]
+| [[Image:ALL-L3 0001.jpg|thumb|Acute lymphoblastic leukemia-L3: Large varied cells with vacuoles (bubble-like features.<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
 |}
 ==References==
 {{Reflist|2}}
-[[Category:Oncology]]
 [[Category:Lymphocytic leukemia]]
 [[Category:Leukemia]]
@@ Line 66: / Line 65: @@
 {{WH}}
 {{WS}}
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Hematology]]
+[[Category:Immunology]]