Subclassification of Acute Myeloid Leukemia

In the minds of several investigators, immunophenotyping of AML is still at best complementary to morphologic evaluation. This is a serious mistake. Certain AML subtypes can only be diagnosed with certainty when detailed immunophenotyping is applied; for example, in minimally differentiated AML and within morphologically defined subgroups, immunophenotyp-ing has provided subclassifications, that are prognostically relevant, as in the case of NK-AML with the morphology of hypogranular APL (FAB-M3v). The WHO classification suggested that, as in ALL, certain cytogenetic—molecular categories be recognized as distinct subtypes in AML.77,78 Surrogate antigen markers already exist for some of these subtypes, for example, CD19/CD56 for t(8;21) leukemia. That the myeloid leukemic immunophenotype may deviate from that of its presumed normal counterstage, despite indistinguishable morphological features, is best exemplified in APL (see below). Phenotypic differences between normal and leukemic cells of similar morphologic appearance are helpful in the immunologic evaluation of remission bone marrows and the detection of residual disease.

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