Acute lymphoblastic leukemia classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Carlos A Lopez, M.D. [3]

Overview

Acute lymphoblastic leukemia may be classified according to either the French-American-British (FAB) classification or World Health Organization (WHO). According to the French-American-British (FAB) classification, acute lymphoblastic leukemia may be classified into 3 subgroups: ALL-L1 (small uniform cells), ALL-L2 (large varied cells) and ALL-L3 (large varied cells with vacuoles). According to the World Health Organization (WHO), acute lymphoblastic leukemia may also be classified into 3 subgroups: B lymphoblastic leukemia/lymphoma, B lymphoblastic leukemia/lymphoma (not organ specific), and B lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities.

Classification

Acute lymphoblastic leukemia may be classified according to either the French-American-British (FAB) classification system or the World Health Organization (WHO) classification system:

French-American-British Classification System

According to the French-American-British classification system, acute lymphoblastic leukemia is classified into 3 subgroups based on the cellular origin of the disease, cellular maturity, and morphology:[1][2]

  • ALL-L1: small uniform cells
  • ALL-L2: large varied cells
  • ALL-L3: large varied cells with vacuoles (bubble-like features)

Each subtype is further classified based on immunophenotyping (the presence of surface markers of the abnormal lymphocytes). There are 2 main immunologic types:

  • pre-B cell
  • pre-T cell

The mature B-cell acute lymphoblastic leukemia (L3) is called Burkitt leukemia/lymphoma.

World Health Organization Classification System

The World Health Organization (WHO) classification of acute lymphoblastic leukemia is based on the prognostication of the disease. According to the WHO classification system, acute lymphoblastic leukemia may be classified into 3 subgroups:[3][4][5]

Group 1

  • B lymphoblastic leukemia/lymphoma

Group 2

  • B lymphoblastic leukemia/lymphoma (Not organ specific)

Group 3

  • B lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities:
  • B lymphoblastic leukemia/lymphoma with t(9;22)(q34;q11.2), BCR-ABL1
  • B lymphoblastic leukemia/lymphoma with t(v;11q23); MLL rearranged
  • B lymphoblastic leukemia/lymphoma with t(12;21)(p13;q22) TEL-AML1 (ETV6-RUNX1)
  • B lymphoblastic leukemia/lymphoma with hyperdiploidy
  • B lymphoblastic leukemia/lymphoma with hypodiploidy
  • B lymphoblastic leukemia/lymphoma with t(5;14)(q31;q32) IL3-IGH
  • B lymphoblastic leukemia/lymphoma with t(1;19)(q23;p13.3) TCF3-PBX1
Acute lymphoblastic leukemia -L1: Small uniform cells subtype.
Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan
Acute lymphoblastic leukemia-L1: Large varied cells subtype.
Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan


Acute lymphoblastic leukemia-L2: Large varied cells (Hand mirror cell).
Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan
Acute lymphoblastic leukemia-L2: Large varied cells.
Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan


Acute lymphoblastic leukemia-L2: Large varied cells.
Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan
Acute lymphoblastic leukemia-L3: Large varied cells with vacuoles (bubble-like features.
Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan

References

  1. van Eys J, Pullen J, Head D, Boyett J, Crist W, Falletta J, Humphrey GB, Jackson J, Riccardi V, Brock B (March 1986). "The French-American-British (FAB) classification of leukemia. The Pediatric Oncology Group experience with lymphocytic leukemia". Cancer. 57 (5): 1046–51. PMID 3484662. 
  2. Lilleyman JS, Hann IM, Stevens RF, Eden OB, Richards SM (September 1986). "French American British (FAB) morphological classification of childhood lymphoblastic leukaemia and its clinical importance". J. Clin. Pathol. 39 (9): 998–1002. PMC 500200Freely accessible. PMID 3463568. 
  3. Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES (2011). "The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications.". Blood. 117 (19): 5019–32. PMC 3109529Freely accessible. PMID 21300984. doi:10.1182/blood-2011-01-293050. 
  4. Chiaretti S, Zini G, Bassan R (2014). "Diagnosis and subclassification of acute lymphoblastic leukemia". Mediterr J Hematol Infect Dis. 6 (1): e2014073. PMC 4235437Freely accessible. PMID 25408859. doi:10.4084/MJHID.2014.073. 
  5. Kebriaei P, Anastasi J, Larson RA (December 2002). "Acute lymphoblastic leukaemia: diagnosis and classification". Best Pract Res Clin Haematol. 15 (4): 597–621. PMID 12617866. 

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