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 the French-American-British classification (FAB) and World Health Organization classification (WHO). The French-American-British classification is divided into 3 groups: ALL-L1: small uniform cells, ALL-L2: large varied cells, ALL-L3: large varied cells with vacuoles (bubble-like features). The World Health Organization classification is divided into three 3 too: B lymphoblastic leukemia/lymphoma, B lymphoblastic leukemia/lymphoma (Not organ specific), B lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities.

Classification

There are 2 classifications regard acute lymphoblastic leukemia, the French-American-British classification and the World Health Organization here you can find a description of both.

French-American-British classification

The French-American-British (FAB) classification of acute lymphoblastic leukemia 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. 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 acute lymphoblastic leukemia (L3) is now classified as Burkitt leukemia/lymphoma.

Classification

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

World Health Organization classification

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 French-American-British (FAB) classification criteria. There are 3 different grups of Lymphoblastic leukemias according to the WHO including a classification with recurrent genetic abnormalities.[1]

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

(Images shown below are courtesy of Melih Aktan MD, Istanbul Medical Faculty - Turkey, and Kyoto University - Japan)

ALL-L1: Small uniform cells subtype
ALL-L1: Large varied cells subtype


ALL-L2: Large varied cells (Hand mirror cell)
ALL-L2: Large varied cells


ALL-L2: Large varied cells
ALL-L3: Large varied cells with vacuoles (bubble-like features

References

  1. 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.

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