alexa Morphological diagnoses of the Japan adult leukemia study group acute myeloid leukemia protocols: central review.
Haematology

Haematology

Journal of Hematology & Thromboembolic Diseases

Author(s): Kuriyama K, Tomonaga M, Kobayashi T, Takeuchi J, Ohshima T,

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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 < or =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.
This article was published in Int J Hematol and referenced in Journal of Hematology & Thromboembolic Diseases

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