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The International Consensus Classification of acute myeloid leukemia

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Abstract

Acute myeloid leukemias (AMLs) are overlapping hematological neoplasms associated with rapid onset, progressive, and frequently chemo-resistant disease. At diagnosis, classification and risk stratification are critical for treatment decisions. A group with expertise in the clinical, pathologic, and genetic aspects of these disorders developed the International Consensus Classification (ICC) of acute leukemias. One of the major changes includes elimination of AML with myelodysplasia-related changes group, while creating new categories of AML with myelodysplasia-related cytogenetic abnormalities, AML with myelodysplasia-related gene mutations, and AML with mutated TP53. Most of recurrent genetic abnormalities, including mutations in NPM1, that define specific subtypes of AML have a lower requirement of ≥ 10% blasts in the bone marrow or blood, and a new category of MDS/AML is created for other case types with 10–19% blasts. Prior therapy, antecedent myeloid neoplasms or underlying germline genetic disorders predisposing to the development of AML are now recommended as qualifiers to the initial diagnosis of AML. With these changes, classification of AML is updated to include evolving genetic, clinical, and morphologic findings.

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Authors and Affiliations

  1. Department of Pathology, University of Texas Southwestern Medical Center, BioCenter, 2230 Inwood Rd, Dallas, TX, EB03.220G75235, USA

    Olga K. Weinberg

  2. Division of Oncology and Pathology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden

    Anna Porwit

  3. Department of Pathology, Texas Tech University Health Sciences Center, El Paso, El Paso, TX, USA

    Attilio Orazi

  4. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA

    Robert P. Hasserjian

  5. Department of Pathology, University of New Mexico, Albuquerque, NM, USA

    Kathryn Foucar

  6. Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA

    Eric J. Duncavage

  7. Department of Pathology, University of Chicago, Chicago, IL, USA

    Daniel A. Arber

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OW, AP, and DA wrote the manuscript. AO, RH, KF, and ED all contributed to the discussion of issues raised in the manuscript and extensively edited the manuscript. All authors have made substantial contributions to this review, have read and approved the final version submitted, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Olga K. Weinberg.

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Weinberg, O.K., Porwit, A., Orazi, A. et al. The International Consensus Classification of acute myeloid leukemia. Virchows Arch 482, 27–37 (2023). https://doi.org/10.1007/s00428-022-03430-4

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  • DOI: https://doi.org/10.1007/s00428-022-03430-4

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