Introduction to Nomenclature and Classification of Acute Leukemias

Abstract

The nomenclature and classification of acute leukemia has been a source of concern and controversy since the earliest clinical description of leukemia nearly 150 years ago. In 1827, Velpeau (cited by Dameshek and Gunz, 1964) described a 63-year- old patient, a florist and seller of lemonade, “who had abandoned himself to the abuse of spirituous liquor and of women without, however, becoming syphilitic”, who presented with an enlarged abdomen, fever and weakness. He died promptly and at autopsy, in addition to hepatosplenomegaly, the blood was thick “like gruel… resembling in consistency and color the yeast of red wine… One might have asked if it were not rather laudable pus… than blood.” DonnÉ in Paris was the first to examine the blood of such a patient microscopically and found more than half of it to consist of “mucous globules” which could not be distinguished from pus corpuscles. Since the relation between the red corpuscles and the white corpuscles was the reverse of normal, Virchow used the term “white blood” to describe the condition. In 1847, he introduced the name “leukemia” and published a series of papers on the nature of the disease which he classified into two forms, “splenic” associated with splenomegaly and “lymphatic” characterized by lymph node enlargement and the presence of white corpuscles in the blood resembling those in the lymph nodes.