Acute Myeloblastic Leukemia Without Cytologic Maturation M0

AML M0 is a rare form of acute myeloid leukemia comprising approximately 2 to 3 percent of AMLs. In 1991 the FAB group criteria10 for AML M0 included less than 3 percent blasts that were positive for MPO, SBB, or both and expression of myeloid associated markers such as CD13 or CD33 with the absence of lymphoid antigens except for TdT.72 Morphologically, blasts are large with open chromatin and prominent single or multiple nucleoli. The N/C ratio is low. Cytoplasm is moderately basophilic. Azurophilic granules or Auer rods are not seen. The diagnosis of AML M0 cannot be made on morphological grounds alone and always requires confirmation by immuno-logical techniques. Application of immunohistochemical stain for myeloperoxidase to the paraffin-embedded bone marrow sections is also useful for confirming myeloid lineage. Some phenotypic differences are found between adult and pediatric AML M0 cases. Adult AML M0 is associated with an immature stem cell profile (TdT, CD34, CD13, and CD33),75-77 in contrast with pediatric AML M0, which usually lacked TdT or CD34 but expressed CD33 with weak or negative CD13.78 Co-expression of the CD7 was observed in both groups. AML M0 was characterized by more frequent occurrence of complex karyotypes and abnormalities of chromosome 5 and/or 7.76>77 The concurrent expression of factors having a negative prognostic impact such as CD7, GP170 (mdr phenotype), complex karyotype, and age over 60 years contributes to the very unfavorable prognosis for AML MO.77,79

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