Review Article

International Journal of Hematology

, Volume 73, Issue 1, pp 93-99

First online:

Morphological diagnoses of the Japan Adult Leukemia Study Group acute myeloid leukemia protocols: Central review

  • Kazutaka KuriyamaAffiliated withDepartment of Hematology and Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University School of Medicine Email author 
  • , Masao TomonagaAffiliated withDepartment of Hematology and Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University School of Medicine
  • , Tohru KobayashiAffiliated withSecond Department of Internal Medicine, Mie University School of Medicine
  • , Jin TakeuchiAffiliated withFirst Department of Internal Medicine, Nihon University School of Medicine
  • , Toshiteru OhshimaAffiliated withSekishindo Hospital
  • , Shinppei FurusawaAffiliated withDepartment of Hematology, Dokkyo University School of Medicine
  • , Kenji SaitohAffiliated withDepartment of Hematology, Dokkyo University School of Medicine
  • , Ryuzo OhnoAffiliated withDepartment of Medicine III, Hamamatsu Medical School

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Abstract

A morphological review system of the Japan Adult Leukemia Study Group has developed from the AML-87 through the AML-92 experience.We reviewed 1427 (90%) of 1592 cases enrolled in the AML-87, -89, or -92 protocols for morphology; 1408 (88%) were eligible. The rate of diagnostic concordance between each institute and the Committee on Morphological Diagnosis ranged from 76% to 80%. Acute myeloid leukemia (AML) subtypes were as follows: AML M0, 27 (2%); M1, 179 (13%); M2, 472 (34%); M3, 358 (25%); M4, 265 (19%); M5, 57 (4%); M6, 39 (3%); and M7, 11 (1%). The reason for the high number of patients with AML M3 is that many M3 patients were enrolled in the AML-92 protocol, which contained all-trans-retinoic acid. AML M0, M6 and M7 belonged to the poor prognostic groups. Auer bodies were found in 284 (53%) of 538 patients who survived significantly longer than those without Auer bodies in AML-87/-89. In AML-92 except for AML M3, 259 (43%) of 602 cases were Auer+ and also showed better survival rates. The survival of patients with >50% myeloperoxidase (MPO)-positive blast cells was better than those with ⩽50% MPO+ blast cells in AML-87/-89. This trend was also seen in AML-92 excluding M3. AML with trilineage dysplasia (AML/TLD) is characterized as a subtype of de novo AML that shows morphological dysplasia of mature hematopoietic cells on a background of leukemic blast cells.The number of patients with AML/TLD was 89 (16.5%) of 545 patients reviewed in AML-87/-89. AML-92, except for M3, showed a higher rate of patients with TLD (161 cases; 27.6%) because there were no patients with TLD in the AML M3 group. Survival rates for AML/TLD were worse than those for AML/non-TLD in both the AML-87/-89 and -92 protocols. Eighty percent of all cases (793/986) entered in AML-92 were analyzed cytogenetically. Fifty-one cases were not available for karyotyping because of a lack of mitoses or inappropriate preparations.The most frequent karyotype was normal, which accounted for 34.2%.The t(15;17), t(8;21), and inv(16) karyotypes, which are regarded as good risk factors, were 23.8%, 9.2%, and 1.6%, respectively. Abnormal chromosomes 5, 7, t(9;22), and t(6;9) were considered to be poor or intermediate risk factors. As a new system of karyotyping begins in the ongoing AML protocol, useful chromosomal data will be obtained in the near future.

Key words

Adult AML Morphological review FAB classification Myeloperoxidase Trilineage myelodysplasia