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{{Acute lymphoblastic leukemia}}
{{Acute lymphoblastic leukemia}}


{{CMG}} {{AE}} {{RT}}
{{CMG}} {{AE}} {{RT}} {{CLG}}
== Overview ==
== Overview ==
Acute lymphoblastic leukemia may be classified according to either the [[French-American-British classification | French-American-British (FAB) classification]] or [[World Health Organization]] (WHO) classification scheme. According to the [[French-American-British classification | 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 [[vacuole]]s). 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 [[Genetics|genetic]] abnormalities.


The classification subtyping of the various forms of Acute limphocytic leukemia used to be done according to the [[French-American-British classification|French-American-British (FAB) classification]], which was used for all Acute leukemias (including [[acute myelogenous leukemia]], (AML)). As Acute lymphoblastic leukemia is not a solid tumour, the [[TNM|TxNxMx]] notation as used in solid cancers only. The recent World Health Organization International panel on Acute lymphoblastic leukemia recommends that this classification be abandoned, since the morphological classification has no clinical or prognostic relevance. But here you can find both classifications for academic and historic porpouses.
== Classification ==
Acute lymphoblastic leukemia may be classified according to either the [[French-American-British classification | French-American-British (FAB)]] classification system or the [[World Health Organization]] (WHO) classification system:


===French-American-British classification===
===French-American-British Classification System===
The [[French-American-British classification | French-American-British (FAB) classification]] system is divided into 3 subtypes L1 to L3 based on the type of cell from which the leukemia developed and its degree of maturity and morphological classification.
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]]:<ref name="pmid3484662">{{cite journal |vauthors=van Eys J, Pullen J, Head D, Boyett J, Crist W, Falletta J, Humphrey GB, Jackson J, Riccardi V, Brock B |title=The French-American-British (FAB) classification of leukemia. The Pediatric Oncology Group experience with lymphocytic leukemia |journal=Cancer |volume=57 |issue=5 |pages=1046–51 |date=March 1986 |pmid=3484662 |doi= |url=}}</ref><ref name="pmid3463568">{{cite journal |vauthors=Lilleyman JS, Hann IM, Stevens RF, Eden OB, Richards SM |title=French American British (FAB) morphological classification of childhood lymphoblastic leukaemia and its clinical importance |journal=J. Clin. Pathol. |volume=39 |issue=9 |pages=998–1002 |date=September 1986 |pmid=3463568 |pmc=500200 |doi= |url=}}</ref>
* ALL-L1: small uniform [[Cells (biology)|cells]]
* ALL-L2: large varied [[Cells (biology)|cells]]
* ALL-L3: large varied [[cells]] with [[vacuole]]s (bubble-like features)


* ALL-L1: small uniform cells
Each subtype is further classified based on [[immunophenotyping]] (the presence of surface markers of the abnormal [[lymphocytes]]). There are 2 main immunologic types:
* ALL-L2: large varied cells
*Pre-B cell<ref name="pmid19901533">{{cite journal| author=Nahar R, Müschen M| title=Pre-B cell receptor signaling in acute lymphoblastic leukemia. | journal=Cell Cycle | year= 2009 | volume= 8 | issue= 23 | pages= 3874-7 | pmid=19901533 | doi=10.4161/cc.8.23.10035 | pmc=4047560 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19901533  }} </ref>
* ALL-L3: large varied cells with [[vacuole]]s (bubble-like features)
*Pre-T cell<ref name="pmid17369128">{{cite journal| author=Han X, Bueso-Ramos CE| title=Precursor T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma and acute biphenotypic leukemias. | journal=Am J Clin Pathol | year= 2007 | volume= 127 | issue= 4 | pages= 528-44 | pmid=17369128 | doi=10.1309/2QE3A6EKQ8UYDYRC | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17369128  }} </ref>


Note: Each subtype is then further classified by determining the surface markers of the abnormal lymphocytes, called immunophenotyping. There are 2 main immunologic types: pre-B cell and pre-T cell. The mature B-cell ALL (L3) is now classified as Burkitt leukemia/lymphoma.  Subtyping helps determine the prognosis and most appropriate treatment in treating ALL.
The mature [[B-cell]] acute lymphoblastic leukemia (L3) is called [[Burkitt lymphoma|Burkitt leukemia/lymphoma]].


===World Health Organization classification ===
===World Health Organization Classification System ===
The [[World Health Organization]] (WHO) classification of Acute lymphoblastic leukemia attempts to be more clinically useful and to produce more meaningful prognostic information than the FAB criteria. There are 3 different grups of Lymphoblastic leukemias according to the WHO including a classification with recurrent genetic abnormalities.
The [[World Health Organization]] (WHO) classification of acute lymphoblastic leukemia is based on the [[prognosis]] of the disease. According to the WHO classification system, acute lymphoblastic leukemia may be classified into 3 subgroups:<ref name="pmid21300984">{{cite journal| author=Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES| title=The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. | journal=Blood | year= 2011 | volume= 117 | issue= 19 | pages= 5019-32 | pmid=21300984 | doi=10.1182/blood-2011-01-293050 | pmc=PMC3109529 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21300984  }} </ref><ref name="pmid25408859">{{cite journal |vauthors=Chiaretti S, Zini G, Bassan R |title=Diagnosis and subclassification of acute lymphoblastic leukemia |journal=Mediterr J Hematol Infect Dis |volume=6 |issue=1 |pages=e2014073 |date=2014 |pmid=25408859 |pmc=4235437 |doi=10.4084/MJHID.2014.073 |url=}}</ref><ref name="pmid12617866">{{cite journal |vauthors=Kebriaei P, Anastasi J, Larson RA |title=Acute lymphoblastic leukaemia: diagnosis and classification |journal=Best Pract Res Clin Haematol |volume=15 |issue=4 |pages=597–621 |date=December 2002 |pmid=12617866 |doi= |url=}}</ref>


===Group 1===
===Group 1===
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*B lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities:
*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 [[Philadelphia chromosome|t(9;22)(q34;q11.2)]], ''[[BCR/ABL|BCR-ABL1]]''
:*B lymphoblastic leukemia/lymphoma with t(v;11q23); MLL rearranged
:*B lymphoblastic leukemia/lymphoma with t(v;11q23); [[MLL (gene)|MLL]] rearranged
:*B lymphoblastic leukemia/lymphoma with t(12;21)(p13;q22) TEL-AML1 (ETV6-RUNX1)
:*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 hyperdiploidy
:*B lymphoblastic leukemia/lymphoma with hypodiploidy
:*B lymphoblastic leukemia/lymphoma with hypodiploidy
:*B lymphoblastic leukemia/lymphoma with t(5;14)(q31;q32) IL3-IGH
:*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
:*B lymphoblastic leukemia/lymphoma with t(1;19)(q23;p13.3) ''TCF3-PBX1''
 
(Images shown below are courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan)


{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:ALL-L1.jpg|thumb|ALL-L1]]
| [[Image:ALL-L1.jpg|thumb|Acute lymphoblastic leukemia -L1: Small uniform cells subtype.<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
| [[Image:ALL-L1 0002.jpg|thumb|ALL-L1]]
| [[Image:ALL-L1 0002.jpg|thumb|Acute lymphoblastic leukemia-L1: Large varied cells subtype.<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
|}
|}


{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:ALL-L2 Hand mirror cell 0001.jpg|thumb|ALL-L2 Hand mirror cell]]
| [[Image:ALL-L2 Hand mirror cell 0001.jpg|thumb|Acute lymphoblastic leukemia-L2: Large varied cells (Hand mirror cell).<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
| [[Image:ALL-L2 0003.jpg|thumb|ALL-L2]]
| [[Image:ALL-L2 0003.jpg|thumb|Acute lymphoblastic leukemia-L2: Large varied cells.<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
|}
|}


{| align="center"
{| align="center"
|-valign="top"
|- valign="top"
| [[Image:ALL-L2 0002.jpg|thumb|ALL-L2]]
| [[Image:ALL-L2 0002.jpg|thumb|Acute lymphoblastic leukemia-L2: Large varied cells.<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
| [[Image:ALL-L3 0001.jpg|thumb|ALL-L3]]
| [[Image:ALL-L3 0001.jpg|thumb|Acute lymphoblastic leukemia-L3: Large varied cells with vacuoles (bubble-like features.<br><sup>Image courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan</sup>]]
|}
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Lymphocytic leukemia]]
[[Category:Leukemia]]


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{{WS}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Immunology]]

Latest revision as of 20:29, 8 April 2019

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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) classification scheme. 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:

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 prognosis of the disease. According to the WHO classification system, acute lymphoblastic leukemia may be classified into 3 subgroups:[5][6][7]

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 500200. PMID 3463568.
  3. ↑ Nahar R, Müschen M (2009). "Pre-B cell receptor signaling in acute lymphoblastic leukemia". Cell Cycle. 8 (23): 3874–7. doi:10.4161/cc.8.23.10035. PMC 4047560. PMID 19901533.
  4. ↑ Han X, Bueso-Ramos CE (2007). "Precursor T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma and acute biphenotypic leukemias". Am J Clin Pathol. 127 (4): 528–44. doi:10.1309/2QE3A6EKQ8UYDYRC. PMID 17369128.
  5. ↑ 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. doi:10.1182/blood-2011-01-293050. PMC 3109529. PMID 21300984.
  6. ↑ Chiaretti S, Zini G, Bassan R (2014). "Diagnosis and subclassification of acute lymphoblastic leukemia". Mediterr J Hematol Infect Dis. 6 (1): e2014073. doi:10.4084/MJHID.2014.073. PMC 4235437. PMID 25408859.
  7. ↑ 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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