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Limitations of the diagnostic criteria for minimally differentiated acute myeloid leukemia (AML-MO)

Leukemia volume 14, pages 2013–2014 (2000)Cite this article

The French–American–British (FAB) cooperative group proposed guidelines for diagnosis of AML-M0 in 1991 to standardize the diagnostic criteria.1 The criteria are as follows: negative for myeloperoxidase (MPO) and the Sudan black B reaction, negative for B and T lineage markers, and positive for myeloid markers. These FAB criteria have been used as the standard in diagnosis of AML-M0 since 1991. With advances in molecular biology, the concept of AML-M0 has been changing. Venditti et al2 suggested a new definition of AML-M0 based on the use of monoclonal antibodies specific for cytoplasmic antigens, where they regarded even cases bearing lymphoid antigens as cases of AML-M0, based on positive findings for anti-MPO and negative findings for cytoplasmic CD3 and cytoplasmic CD22. They weighed the expression of cytoplasmic MPO in the diagnosis of AML-M0, and the expression of lymphoid markers is not necessarily evidence against a diagnosis of AML-M0 according to their criteria. However, it remains unknown which of the criteria are most useful for the diagnosis of AML-M0, and any diagnostic criteria of AML-M0 are not comprehensive.

We recently experienced a patient who was diagnosed as AML-M0 based upon the FAB criteria.1 A 36-year-old man with high-grade fever was admitted to our hospital in December 1999. The white blood cell count in peripheral blood was elevated to 13.8 × 106/l, of which 71.5% were blastic cells. Bone marrow examination showed that more than 90% of the bone marrow cells were blasts, of which less than 3% were positive for myeloperoxidase (MPO) upon staining. Fluorescence-activated cell sorter (FACS) examination of the bone marrow specimen showed that these cells were positive for CD7, CD13, CD34, CD45, TdT and HLA-DR, but negative for CD2, CD3, CD4, CD5, CD8, CD10, CD14, CD16, CD19, CD20, cCD22, CD33, CD41a and CD56. He was diagnosed as AML-M0 based on the FAB classification.1 He received the standard induction therapy for AML, but to no avail. After the initiation of induction therapy, we further evaluated the characteristics of the leukemic cells. The karyotype of the leukemic cells was normal. Southern blot analysis of the bone marrow showed that neither immunoglobulin heavy chain (IgH) nor T cell receptor (TCR), including the beta, gamma and delta chains, was rearranged. Electron microscopic examination of the leukemic cells showed that the blasts lacked granules with peroxidase activity, but had nuclear pockets, and clustered dense bodies. These findings are characteristic of the pro-thymocytes. FACS analysis using monoclonal antibodies showed that the leukemic cells were negative for cytoplasmic CD22 and cytoplasmic MPO, but cytoplasmic CD3 was highly expressed in these cells. We therefore considered that these leukemic cells might have been committed to the T cell lineage. We initiated anti-ALL reinduction treatment 36 days after the initial chemotherapy. Complete remission was achieved on day 28 of the second induction therapy. He is now receiving consolidation therapy for ALL.

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Authors and Affiliations

  1. Dept of Hematology, Toranomon Hospital, Tokyo, Japan

    H Iwata, M Kami, Y Kishi, Y Oki, S Morinaga & Y Mutou

  2. Dept of Hematology and Oncology, University of Tokyo Hospital, Tokyo, Japan

    Y Tanaka

  3. Dept of Pathology, University of Tokyo Hospital, Tokyo, Japan

    K Takeuchi

  4. Dept of Clinical Laboratory and Pathology, Hematology, Inoue Memorial Hospital, Chiba, Japan

    I Yamazaki

  5. Laboratory of Chemotherapy, Aichi Cancer Center, Aichi, Japan

    R Suzuki

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Iwata, H., Kami, M., Kishi, Y. et al. Limitations of the diagnostic criteria for minimally differentiated acute myeloid leukemia (AML-MO). Leukemia 14, 2013–2014 (2000). https://doi.org/10.1038/sj.leu.2401927

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