Abstract
In this presentation we have reviewed the cytological classification and subclassification of acute leukaemias (AL) and indicated the correlation which exists between the different varieties and types of AL and their therapeutic responsiveness and prognosis. AL is classically divided into three main types: acute lymphoid leukaemia (ALL), acute myeloid leukaemia (AML) and acute monocytoid leukaemia (AMoL) which are characterized by great differences in therapeutic sensitivity and duration of survival. An intermediate variety between AML and AMoL is distinguished which often requires the sequential combination of the respective treatments of these two varieties for obtaining a remission.
A more sophisticated investigation led us to individualise several types within each variety.
Within the framework of ALL, we distinguish five types: the prolymphocytic, microlymphoblastic, macrolymphoblastic, prolymphoblastic and immunoblastic acute lymphoid leukaemias. Using computer analysis, we demonstrated that, among all the prognostic factors, i.e. type, age, tumour volume, leukocytosis..., the cytological type remains the only one which determines the other factors. The best therapeutic response and prognosis are obtained with the microlymphoblastic and prolymphocytic types which are sensitive to immunotherapy, while the macrolymphoblastic is insensitive to the latter but sensitive to chemotherapy, and while the prolymphoblastic and the immunoblastic ones are more resistant to chemotherapy and possess the poorest prognosis.
Within AML, we have distinguished the typical myeloblastic, promyeloblastic and promyelocytic types according to cytological criteria. There is, however, no significant difference concerning the prognosis of these types which remains poor.
Within AMoL, we have distinguished the typical monoblastic, promonocytic and promonoblastic types, but there is as yet no significant difference in their prognosis.
The blastic crisis of chronic myeloid leukaemia poses the question of the origin and nature of the blastic cell population which can be of the myeloblastic type or possess a lymphoblast-like appearance. In spite of these cytological differences, we have been unable to demonstrate any difference in the survival of blastic crisis bearing patients, but we have shown that the small cell lymphoblast-like type can be sensitive to ALL treatment.
Requests for reprints to: G. Mathé, Institut de Cancérologie et d’Immunogénétique, Hôpital Paul-Brousse, 14–16, avenue Paul Vaillant Couturier, 94800-Villejuif, France.
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Mathé, G. et al. (1975). Search for Correlations between Cytological Types and Therapeutic Sensitivity of Acute Leukaemias. In: Bessis, M., Brecher, G. (eds) Unclassifiable Leukemias. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-66126-6_5
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DOI: https://doi.org/10.1007/978-3-642-66126-6_5
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