Acute myeloid leukemia classification
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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 myeloid leukemia may be classified according to the French-American-British (FAB) classification and World Health Organization (WHO).
Classification
There are 3 classifications systems for acute myeloid leukemia. These include the French-American-British (FAB) classification, the World Health Organization (WHO) classification, and the European LeukemiaNet (ELN) classification.
French-American-British classification
The French-American-British (FAB) classification system divided acute myeloid leukemia into 8 subtypes, M0 through to M7, based on the type of cell from which the leukemia developed and its degree of maturity. This is done by examining the appearance of the malignant cells under light microscopy and/or by using cytogenetics to characterize any underlying chromosomal abnormalities. The subtypes have varying prognoses and responses to therapy. Although the WHO classification (see below) may be more useful, the FAB system is still widely used as of mid-2006.
The eight FAB subtypes are:[1]
| Type | Name | Cytogenetics |
|---|---|---|
| M0 | Minimally differentiated AML | |
| M1 | Acute myeloblastic leukemia, without maturation | |
| M2 | Acute myeloblastic leukemia, with granulocytic maturation | t(8;21)(q22;q22), t(6;9) |
| M3 | Promyelocytic, or Acute promyelocytic leukemia (APL) | t(15;17) |
| M4 | Acute myelomonocytic leukemia | inv(16)(p13q22), del(16q) |
| M4eo | Myelomonocytic together with bone marrow eosinophilia | inv(16), t(16;16) |
| M5 | Acute monoblastic leukemia (M5a) or Acute monocytic leukemia (M5b) | del (11q), t(9;11), t(11;19) |
| M6 | Acute erythroid leukemias, including erythroleukemia (M6a) and very rare pure erythroid leukemia (M6b) | |
| M7 | Acute megakaryoblastic leukemia | t(1;22) |
World Health Organization classification
The World Health Organization (WHO) classification of acute myeloid leukemia attempts to be more clinically useful and to produce more meaningful prognostic information than the FAB criteria. Each of the WHO categories contains numerous descriptive sub-categories of interest to the hematopathologist and oncologist; however, most of the clinically significant information in the WHO schema is communicated via categorization into one of the five subtypes listed below.
The subtypes of acute myeloid leukemia are shown below:[2]
| Name | Description | ICD-O |
|---|---|---|
| Acute myeloid leukemia with characteristic genetic abnormalities | Includes:
Patients with acute myeloid leukemia in this category generally have a high rate of remission and a better prognosis compared to other types of acute myeloid leukemia. |
Multiple |
| Acute myeloid leukemia with multilineage dysplasia | This category includes patients who have had a prior myelodysplastic syndrome (MDS) or myeloproliferative disease (MPD) that transforms into acute myeloid leukemia. This category of acute myeloid leukemia occurs most often in elderly patients and often has a worse prognosis. | Template:ICDO |
| Acute myeloid leukemia and MDS, therapy-related | This category includes patients who have had prior chemotherapy and/or radiation and subsequently develop acute myeloid leukemia or MDS. These leukemias may be characterized by specific chromosomal abnormalities, and often carry a worse prognosis. | Template:ICDO |
| Acute myeloid leukemia not otherwise categorized | Includes subtypes of acute myeloid leukemia that do not fall into the above categories. | Template:ICDO |
European LeukemiaNet classification
| Name | Description |
|---|---|
| Acute myeloid leukemia with characteristic genetic abnormalities | Includes:
Patients with acute myeloid leukemia in this category generally have a high rate of remission and a better prognosis compared to other types of acute myeloid leukemia. |
| Acute myeloid leukemia with multilineage dysplasia | This category includes patients who have had a prior myelodysplastic syndrome (MDS) or myeloproliferative disease (MPD) that transforms into acute myeloid leukemia. This category of acute myeloid leukemia occurs most often in elderly patients and often has a worse prognosis. |
| Acute myeloid leukemia and MDS, therapy-related | This category includes patients who have had prior chemotherapy and/or radiation and subsequently develop acute myeloid leukemia or MDS. These leukemias may be characterized by specific chromosomal abnormalities, and often carry a worse prognosis. |
| Acute myeloid leukemia not otherwise categorized | Includes subtypes of acute myeloid leukemia that do not fall into the above categories. |
References
- ↑ Bennett J, Catovsky D, Daniel M, Flandrin G, Galton D, Gralnick H, Sultan C (1976). "Proposals for the classification of the acute leukaemias. French-American-British (FAB) co-operative group". Br J Haematol. 33 (4): 451–8. PMID 188440.
- ↑ Vardiman J, Harris N, Brunning R (2002). "The World Health Organization (WHO) classification of the myeloid neoplasms". Blood. 100 (7): 2292–302. PMID 12239137. Full text.