Book contents
- Frontmatter
- Contents
- Preface
- 1 Introduction
- 2 The normal bone marrow and an approach to bone marrow evaluation of neoplastic and proliferative processes
- 3 Granulomatous and histiocytic disorders
- 4 The aplasias
- 5 The hyperplasias
- 6 Other non-neoplastic marrow changes
- 7 Myelodysplastic syndromes
- 8 Acute leukemia
- 9 Chronic myeloproliferative disorders and systemic mastocytosis
- 10 Myelodysplastic/myeloproliferative disorders
- 11 Chronic lymphoproliferative disorders and malignant lymphoma
- 12 Immunosecretory disorders/plasma cell disorders and lymphoplasmacytic lymphoma
- 13 Metastatic lesions
- 14 Post-therapy bone marrow changes
- Index
- References
8 - Acute leukemia
Published online by Cambridge University Press: 07 August 2009
- Frontmatter
- Contents
- Preface
- 1 Introduction
- 2 The normal bone marrow and an approach to bone marrow evaluation of neoplastic and proliferative processes
- 3 Granulomatous and histiocytic disorders
- 4 The aplasias
- 5 The hyperplasias
- 6 Other non-neoplastic marrow changes
- 7 Myelodysplastic syndromes
- 8 Acute leukemia
- 9 Chronic myeloproliferative disorders and systemic mastocytosis
- 10 Myelodysplastic/myeloproliferative disorders
- 11 Chronic lymphoproliferative disorders and malignant lymphoma
- 12 Immunosecretory disorders/plasma cell disorders and lymphoplasmacytic lymphoma
- 13 Metastatic lesions
- 14 Post-therapy bone marrow changes
- Index
- References
Summary
Introduction
Acute leukemia is a proliferation of immature bone marrow-derived cells (blasts) that may also involve peripheral blood or solid organs. The percentage of bone marrow blast cells required for a diagnosis of acute leukemia has traditionally been set arbitrarily at 30% or more. However, more recently proposed classification systems have lowered the blast cell count to 20% for many leukemia types, and do not require any minimum blast cell percentage when certain morphologic and cytogenetic features are present.
The traditional classification of acute leukemia used criteria proposed by the French–American–British Cooperative Group (FAB) (Table 8.1), using the 30% bone marrow blast cell cutoff (Bennett et al., 1976, 1985a). This classification system originally distinguished different leukemia types by morphologic features and cytochemical studies, particularly myeloperoxidase (or Sudan black B) and non-specific esterase staining. It was revised to include leukemia types that could only be accurately identified with the addition of immunophenotyping or electron microscopic studies (Bennett et al., 1985b, 1991). Although the FAB classification failed to distinguish immunophenotypic groups of acute lymphoblastic leukemias, did not recognize the significance of myelodysplastic changes in acute myeloid leukemias or cytogenetic abnormalities in either leukemia type, and resulted in some subcategories of little clinical significance, this system provided very clear guidelines for classification. In addition, some distinct leukemia subtypes, particularly acute promyelocytic leukemia and acute myeloid leukemia with abnormal eosinophils, were found to correlate with specific cytogenetic aberrations and had unique clinical features, and those remain in recently proposed classification systems.
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- Information
- Illustrated Pathology of the Bone Marrow , pp. 58 - 72Publisher: Cambridge University PressPrint publication year: 2006