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    Adult Acute Myeloid Leukemia Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Classification of Adult Acute Myeloid Leukemia

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    Common morphologic features include the following:

    • Large blasts with abundant basophilic cytoplasm, often containing numerous azurophilic granules.
    • A few blasts in some cases show very large granules (pseudo Chediak-Higashi granules).
    • Auer rods, which may be detected in mature neutrophils.
    • Smaller blasts, predominantly in the peripheral blood.
    • Promyelocytes, myelocytes, and mature neutrophils with variable dysplasia in the bone marrow.
    • Abnormal nuclear segmentation (pseudo Pelger-Huet nuclei) and/or cytoplasmic staining abnormalities.
    • Increased eosinophil precursors.
    • Reduced or absent monocytes.
    • Normal erythroblasts and megakaryocytes.

    AML with maturation (FAB classification M2) is the most common morphologic type correlating with t(8; 21). Rarely, AML with this translocation presents with a bone marrow blast percentage less than 20%.[13]

    The translocation t(8; 21)(q22; q22) involves the AML1 gene, also known as RUNX1, which encodes CBF-alpha, and the ETO (eight-twenty-one) gene.[13,15] The AML1/ETO fusion transcript is consistently detected in patients with t(8; 21) AML. This type of AML is usually associated with a good response to chemotherapy and a high complete remission (CR) rate with long-term survival when treated with high-dose cytarabine in the postremission phase as in the Cancer and Leukemia Group B (CLB-9022 and CLB-8525) trials.[16,17,18,19] Additional chromosome abnormalities are common, for example, loss of a sex chromosome and del(9)(q22). Expression of the neural-cell adhesion molecule (CD56) appears to be an adverse prognostic indicator.[20,21]

    Acute myeloid leukemia with inv(16)(p13; q22) or t(16; 16)(p13; q22); (CBFβ/MYH11)

    AML with inv(16)(p13; q22) or t(16; 16)(p13; q22) is found in approximately 10% to 12% of all cases of AML, predominantly in younger patients.[13,22] Morphologically, this type of AML is associated with acute myelomonocytic leukemia (FAB classification M4) with abnormal eosinophils (AMML Eo). Myeloid sarcomas may be present at initial diagnosis or at relapse.

    Common morphologic features include the following:

    • Monocytic and granulocytic differentiation.
    • A characteristically abnormal eosinophil component with immature purple-violet eosinophil granules that may obscure cell morphology if present in great numbers.
    • Auer rods in myeloblasts.
    • Decreased neutrophils in bone marrow.
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