Skip to main content
SpringerLink
Log in

Morphological diagnoses of the Japan Adult Leukemia Study Group acute myeloid leukemia protocols: Central review

  • Review Article
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

A morphological review system of the Japan Adult Leukemia Study Group has developed from the AML-87 through the AML-92 experience.We reviewed 1427 (90%) of 1592 cases enrolled in the AML-87, -89, or -92 protocols for morphology; 1408 (88%) were eligible. The rate of diagnostic concordance between each institute and the Committee on Morphological Diagnosis ranged from 76% to 80%. Acute myeloid leukemia (AML) subtypes were as follows: AML M0, 27 (2%); M1, 179 (13%); M2, 472 (34%); M3, 358 (25%); M4, 265 (19%); M5, 57 (4%); M6, 39 (3%); and M7, 11 (1%). The reason for the high number of patients with AML M3 is that many M3 patients were enrolled in the AML-92 protocol, which contained all-trans-retinoic acid. AML M0, M6 and M7 belonged to the poor prognostic groups. Auer bodies were found in 284 (53%) of 538 patients who survived significantly longer than those without Auer bodies in AML-87/-89. In AML-92 except for AML M3, 259 (43%) of 602 cases were Auer+ and also showed better survival rates. The survival of patients with >50% myeloperoxidase (MPO)-positive blast cells was better than those with ⩽50% MPO+ blast cells in AML-87/-89. This trend was also seen in AML-92 excluding M3. AML with trilineage dysplasia (AML/TLD) is characterized as a subtype of de novo AML that shows morphological dysplasia of mature hematopoietic cells on a background of leukemic blast cells.The number of patients with AML/TLD was 89 (16.5%) of 545 patients reviewed in AML-87/-89. AML-92, except for M3, showed a higher rate of patients with TLD (161 cases; 27.6%) because there were no patients with TLD in the AML M3 group. Survival rates for AML/TLD were worse than those for AML/non-TLD in both the AML-87/-89 and -92 protocols. Eighty percent of all cases (793/986) entered in AML-92 were analyzed cytogenetically. Fifty-one cases were not available for karyotyping because of a lack of mitoses or inappropriate preparations.The most frequent karyotype was normal, which accounted for 34.2%.The t(15;17), t(8;21), and inv(16) karyotypes, which are regarded as good risk factors, were 23.8%, 9.2%, and 1.6%, respectively. Abnormal chromosomes 5, 7, t(9;22), and t(6;9) were considered to be poor or intermediate risk factors. As a new system of karyotyping begins in the ongoing AML protocol, useful chromosomal data will be obtained in the near future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bennett JM, Catovsky D, Daniel MT, et al. Proposals for the classification of acute leukaemias.Br J Haematol. 1976;33:451–458.

    Article  CAS  PubMed  Google Scholar 

  2. Bennett JM, Catovsky D, Daniel MT, et al. Proposed revised criteria for the classification of acute myeloid leukemia.Ann Intern Med. 1985;103:626–629.

    Google Scholar 

  3. Bennett JM, Catovsky D, Daniel MT, et al. Criteria for the diagnosis of acute leukemia of megakaryocyte lineage (M7).Ann Intern Med. 1985;103:460–462.

    CAS  PubMed  Google Scholar 

  4. Bennett JM, Catovsky D, Daniel MT, et al. Proposal for the recognition of minimally differentiated acute myeloid leukaemia (AML-M0).Br J Haematol. 1991;78:325–329.

    Article  CAS  PubMed  Google Scholar 

  5. Ohno R, Kobayashi T, Tanimoto M, et al. Randomized study of individualized induction therapy with or without vincristine, and of maintenance-intensification therapy between 4 or 12 courses in adult acute myeloid leukemia.Cancer. 1993;71:3888–3895.

    Article  CAS  PubMed  Google Scholar 

  6. Kobayashi T, Miyawaki S, Tanimoto M, et al. Randomized trials between behenoyl cytarabine and cytarabine in combination induction and consolidation therapy, and with or without uben-imex after maintenance/intensification therapy in adult acute myeloid leukemia. The Japan Leukemia Study Group.J Clin Oncol. 1996;14:204–213.

    CAS  PubMed  Google Scholar 

  7. Miyawaki S, Tanimoto M, Kobayashi T, et al. No beneficial effect from addition of etoposide to daunorubicin, cytarabine, and 6-mercaptopurine in individualized induction therapy of adult acute myeloid leukemia: the JALSG-AML92 study. Japan Adult Leukemia Study Group.Int J Hematol. 1999;70:97–104.

    CAS  PubMed  Google Scholar 

  8. Kanamaru A, Takemoto Y, Tanimoto M, et al. All-trans retinoic acid for the treatment of newly diagnosed acute promyelocytic leukemia.Blood. 1995;85:1202–1206.

    CAS  PubMed  Google Scholar 

  9. Asou N, Adachi K, Tamura J, et al. Analysis of prognostic factors in newly diagnosed acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy.J Clin Oncol. 1998;16:78–85.

    CAS  PubMed  Google Scholar 

  10. Tulliez M, Breton-Gorius J. Three types of Auer bodies in acute leukemia. Visualization of their protein by negative contrast after peroxidase cytochemistry.Lab Invest. 1979;41:419–426.

    CAS  PubMed  Google Scholar 

  11. Hassan HT, Rees JK. Auer bodies in acute myeloid leukaemia patients.Pathol Res Pract. 1990;186:293–295.

    CAS  PubMed  Google Scholar 

  12. Scott CS, Den Ottolander GJ, Swirsky D, et al. Recommended procedures for the classification of acute leukaemias.Leuk Lymphoma. 1995;18(Suppl 1):1–12.

    Article  PubMed  Google Scholar 

  13. Brito-Babapulle F, Catovsky D, Galton DA. Clinical and laboratory features of de novo acute myeloid leukaemia with trilineage myelodysplasia.Br J Haematol. 1987;66:445–450.

    Article  CAS  PubMed  Google Scholar 

  14. Kuriyama K, Tomonaga M, Matsuo T, et al. Poor response to intensive chemotherapy in de novo acute myeloid leukaemia with trilineage myelodysplasia. Japan Adult Leukaemia Study Group (JALSG).Br J Haematol. 1994;86:767–773.

    Article  CAS  PubMed  Google Scholar 

  15. Estienne MH, Fenaux P, Preudhomme C, et al. Prognostic value of dysmyelopoietic features in de novo acute myeloid leukaemia: a report on 132 patients.Clin Lab Haematol. 1990;12:57–65.

    Article  CAS  PubMed  Google Scholar 

  16. Goasguen JE, Matsuo T, Cox C, Bennett JM. Evaluation of the dysmyelopoiesis in 336 patients with de novo acute myeloid leukemia: major importance of dysgranulopoiesis for remission and survival.Leukemia. 1992;6:520–525.

    CAS  PubMed  Google Scholar 

  17. Schiffer CA, Lee EJ, Tomiyasu T, Wiernik PH, Testa JR. Prognostic impact of cytogenetic abnormalities in patients with de novo acute nonlymphocytic leukemia.Blood. 1989;73:263–270.

    CAS  PubMed  Google Scholar 

  18. Grimwade D, Walker H, Oliver F, et al. The importance of diagnostic cytogenetics on outcome in AML: analysis of 1,612 patients entered into the MRC AML 10 trial.The Medical Research Council Adult and Children’s Leukaemia Working Parties.Blood. 1998;92:2322–2333.

    CAS  PubMed  Google Scholar 

  19. Dastugue N, Payen C, Lafage-Pochitaloff M, et al. Prognostic significance of karyotype in de novo adult acute myeloid leukemia.Leukemia. 1995;9:1491–1498.

    CAS  PubMed  Google Scholar 

  20. Buchner T, Hiddemann W, Wormann B, et al. Double induction strategy for acute myeloid leukemia: the effect of high-dose cytarabine with mitoxantrone instead of standard-dose cytarabine with daunorubicin and 6-thioguanine: a randomized trial by the German AML Cooperative Group.Blood. 1999;93:4116–4124.

    CAS  PubMed  Google Scholar 

  21. Leith CP, Kopecky KJ, Godwin J, et al. Acute myeloid leukemia in the elderly: assessment of multidrug resistance (MDR1) and cyto-genetics distinguishes biologic subgroups with remarkably distinct responses to standard chemotherapy. A Southwest Oncology Group Study.Blood. 1997;89:3323–3329.

    CAS  PubMed  Google Scholar 

  22. Fenaux P, Preudhomme C, Lai JL, Morel P, Beuscart R, Bauters F. Cytogenetics and their prognostic value in de novo acute myeloid leukaemia: a report on 283 cases.Br J Haematol. 1989;73:61–67.

    Article  CAS  PubMed  Google Scholar 

  23. Hann IM, Stevens RF, Goldstone AH, et al. Randomized comparison of DAT versus ADE as induction chemotherapy in children and younger adults with acute myeloid leukemia. Results of the Medical Research Council’s 10th AML trial (MRC AML10).Blood. 1997;89:2311–2318.

    CAS  PubMed  Google Scholar 

  24. Cassileth PA, Lynch E, Hines JD, et al. Varying intensity of postremission therapy in acute myeloid leukemia.Blood. 1992;79:1924–1930.

    CAS  PubMed  Google Scholar 

  25. Mayer RJ, Davis RB, Schiffer CA, et al. Intensive postremission chemotherapy in adults with acute myeloid leukemia.N Engl J Med. 1994;331:896–903.

    Article  CAS  PubMed  Google Scholar 

  26. Douer D, Preston-Martin S, Chang E, Nichols PW, Watkins KJ, Levine AM. High frequency of acute promyelocytic leukemia among Latinos with acute myeloid leukemia.Blood. 1996;87:308–313.

    CAS  PubMed  Google Scholar 

  27. Stasi R, Del Poeta G, Venditti A, et al. Analysis of treatment failure in patients with minimally differentiated acute myeloid leukemia (AML-M0).Blood. 1994;83:1619–1625.

    CAS  PubMed  Google Scholar 

  28. Olopade OI, Thangavelu M, Larson RA, et al. Clinical, morphologic, and cytogenetic characteristics of 26 patients with acute erythroblastic leukemia.Blood. 1992;80:2873–2882.

    CAS  PubMed  Google Scholar 

  29. Cuneo A, Mecucci C, Kerim S, et al. Multipotent stem cell involvement in megakaryoblastic leukemia: cytologic and cytogenetic evidence in 15 patients.Blood. 1989;74:1781–1790.

    CAS  PubMed  Google Scholar 

  30. Hoyle CF, Gray RG, Wheatley K, et al. Prognostic importance of Sudan Black positivity: a study of bone marrow slides from 1,386 patients with de novo acute myeloid leukaemia.Br J Haematol. 1991;79:398–407.

    Article  CAS  PubMed  Google Scholar 

  31. Matsuo T, Cox C, Bennett JM. Prognostic significance of myeloperoxidase positivity of blast cells in acute myeloblastic leukemia without maturation (FAB: M1): an ECOG study.Hematol Pathol. 1989;3:153–158.

    CAS  PubMed  Google Scholar 

  32. Jinnai I, Tomonaga M, Kuriyama K, et al. Dysmegakaryocytopoiesis in acute leukaemias: its predominance in myelomonocytic (M4) leukaemia and implication for poor response to chemotherapy.Br J Haematol. 1987;66:467–472.

    Article  CAS  PubMed  Google Scholar 

  33. Bennett JM, Catovsky D, Daniel MT, et al: Proposals for the classification of myelodysplastic syndromes.Br J Haematol. 1982;51:189–199.

    CAS  PubMed  Google Scholar 

  34. Harris NL, Jaffe ES, Diebold J, et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting— Airlie House, Virginia, November 1997.J Clin Oncol. 1999;17:3835–3849.

    CAS  PubMed  Google Scholar 

  35. Bennett JM. WHO classification of the acute leukemias and myelodysplastic syndrome.Int J Hematol. 2000;72:131–133.

    CAS  PubMed  Google Scholar 

  36. Taguchi J, Miyazaki Y, Yoshida S, et al. Allogeneic bone marrow transplantation improves the outcome of de novo AML with trilineage dysplasia (AML-TLD).Leukemia. 2000;14:1861–1866.

    Article  CAS  PubMed  Google Scholar 

  37. Wheatley K, Burnett AK, Goldstone AH, et al. A simple, robust, validated and highly predictive index for the determination of risk-directed therapy in acute myeloid leukaemia derived from the MRC AML 10 trial. United Kingdom Medical Research Council’s Adult and Childhood Leukaemia Working Parties.Br J Haematol. 1999;107:69–79.

    Article  CAS  PubMed  Google Scholar 

  38. Bloomfield CD, Lawrence D, Byrd JC, et al. Frequency of prolonged remission duration after high-dose cytarabine intensification in acute myeloid leukemia varies by cytogenetic subtype.Cancer Res. 1998;58:4173–4179.

    CAS  PubMed  Google Scholar 

  39. Byrd JC, Dodge RK, Carroll A, et al. Patients with t(8;21)(q22;q22) and acute myeloid leukemia have superior failure-free and overall survival when repetitive cycles of high-dose cytarabine are administered.J Clin Oncol. 1999;17:3767–3775.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hematology and Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University School of Medicine, Nagasaki, Japan

    Kazutaka Kuriyama & Masao Tomonaga

  2. Second Department of Internal Medicine, Mie University School of Medicine, Tsu, Japan

    Tohru Kobayashi

  3. First Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan

    Jin Takeuchi

  4. Sekishindo Hospital, Kawagoe, Japan

    Toshiteru Ohshima

  5. Department of Hematology, Dokkyo University School of Medicine, Tochigi, Japan

    Shinppei Furusawa & Kenji Saitoh

  6. Department of Medicine III, Hamamatsu Medical School, Hamamatsu, Japan

    Ryuzo Ohno

Authors
  1. Kazutaka Kuriyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masao Tomonaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tohru Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toshiteru Ohshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shinppei Furusawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kenji Saitoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ryuzo Ohno
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kazutaka Kuriyama.

About this article

Cite this article

Kuriyama, K., Tomonaga, M., Kobayashi, T. et al. Morphological diagnoses of the Japan Adult Leukemia Study Group acute myeloid leukemia protocols: Central review. Int J Hematol 73, 93–99 (2001). https://doi.org/10.1007/BF02981909

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02981909

Key words

Search

Navigation