Cytologie Beenmerg - Classificatie

 

FAB-CLASSIFICATION OF AML (³ 30% blasts in bone marrow)
MO ³ 30% Blasts: Myeloperoxidase < 3% pos. plus at least one pos. myeloid marker (CD13, CD33, CD15, CDw65) in absence of lymfoid markers (CD3, CD5, CD10, CD19, CD22).
MI

            >90% (type I plus II) of NEC, of which ³ 3% Myeloperoxidase positive.Maturing monocytic or granulocytic component £ 10%.

M2 Blasts 30-89% (type I plus II) of  NEC
> 10% maturing granulocytic component
< 20% monocytic cells.
M3 "Majority of cells" are promyelocytes (hypergranular, bundles of Auerrods).
M3V Variant: Microgranular promyelocytes (hypogranular, bilobated nucleus).
M4 Blasts ³ 30% of NEC, with >20% granulocytic component, plus at least one of the following:
³
5 x 109/l mature monocytic cells periferally, or
³ 3x increased urine-/serumlysozymes or
³
20% pos. a-Naphtyl-Butyraat-Esterase in BM, or monocytic cells
M4E M4 ³ 5% abnormal eosinophils ± large basophilic granules
M5A ³ 80% monocytic component of NEC with:
³ 80% monoblasts of the monocytic component.
M5B ³ 80% of monocytic component of NEC with
< 80% monoblasts of the monocytic component.
M6 ³ 50% erythroblasts of all nucleated cells, plus
³
30% blast cells of NEC.
M7 Blasts ³ 30% of all nucleated cells, megakaryoblastic origin confirmed by positivity for
CD 41/61 and/or platelet specific
WHO CLASSIFICATION OF AML ( 20 % blasten op ANC)
1. AML with recurrent cytogenetic translocations

- AML with t(8;21) (q22;q22), AML1/ETO
- Acute PML with t(15;17) (q22;q21), PML/RAR-alfa
- Variant acute PML with t(v;17), v/RARalfa
- AML with abnormal bone marrow eosinophils inv(16) (p13;q22) or t(16;16) (q13;q22), CBFbeta/MYH11
- AML with 11q23, MLL gen abnormalities

2. AML with multilineage dysplasia

- With prior myelodysplastic syndrome or myelodysplastic syndrome/myeloproliferative disorder
- Without prior myelodysplastic syndrome

3. AML and myelodysplastic syndrome, therapy related

- Alkylating agent related
- Topoisomerase II inhibitor related
- Other types

4 . AML not otherwise categorized (AML NOS)

- AML minimally differentiated
- AML without maturation
- AML with maturation
- Acute myelomonocytic leukemia
- Acute monocytic leukemia
- Acute erythroid leukemia
- Acute megakaryocytic leukemia
- Acute basophilic leukemia
- Acute panmyelosis with myelofibrosis
FAB CLASSIFICATION  AML/MDS

From Barbara J. Bain, Leukaemia diagnosis, A guide to the FAB classification. Gower Medical Publishing, London WIP 5FB/ J.B. Lippincott Company, Philadelphia, ISBN 0 397 44608 X, 1990.
Diagnose schema AML versus MDS

From Barbara J. Bain, Leukaemia diagnosis, A guide to the FAB classification. Gower Medical Publishing, London WIP 5FB/ J.B. Lippincott Company, Philadelphia, ISBN 0 397 44608 X, 1990.
FAB CLASSIFICATION  OF  MYELODYSPLASTIC  SYNDROMES
  BLOOD   BONE MARROW
1. Refractory anaemia blasts < 1%
(dyspl. +)
and blasts < 5% (count on ANC)
ringsideroblasts < 15%
2. Refractory anaemia with ringsideroblasts (RARS) blasts < 1%
(dyspl. +)
and blasts < 5% (count on ANC)
ringsideroblasts
³ 15%
3. Refractory anaemia with ex­cess of blasts (RAEB) blasts < 5%
(dyspl. ++)
and blasts 5 - <20%
4. Refractory anaemia with ex­cess of blasts in transfor­mation (RAEB-t) blasts > 5%
(dyspl. ++) or with Auerrods
or blasts 20 - <30 %
or with Auerrods
5.Chronic myelo-monocytic leu­kaemia (CMMOL) monocytes > 1 x 109/L blasts < 5% (dyspl. ±) and blasts up to 20%
monocytic component increased
WHO CLASSIFICATION  OF  MYELODYSPLASTIC  SYNDROMES
  BLOOD BONE MARROW
Refractory anaemia (RA) Anemia
Blasts < 1%
Erythroid dysplasia only
Blasts < 5%
Ringsideroblasts < 15% (count on erythroblasts)

Refractory anaemia with ringsideroblasts (RARS)

Anemia
Blasts < 1%

Erythroid dysplasia only
Blasts < 5%
Ringsideroblasts
³
15% (count on erythroblasts)

Refractory cytopenia with multilineage dysplasia (RCMD)

Cytopenias (bicytopenia or pancytopenia )
No or rare blasts
No Auer rods
< 1 x 109/L monocytes

Dysplasia in ³ 10 % of the cells in two or more myeloid cell lines
Blasts < 5%
No Auer rods
Ringed sideroblasts <15 %

Refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD)

Cytopenias (bicytopenia or pancytopenia )
No or rare blasts
No Auer rods
< 1 x 109/L monocytes

Dysplasia in ³ 10 % of the cells in two or more myeloid cell lines
Blasts < 5%
No Auer rods
Ringed sideroblasts
³15 %

Refractory anaemia with excess of blasts -1 (RAEB- 1)

Cytopenias
Blasts < 5%
No Auer rods
monocytes  < 1x109/L

Unilineage or multilineage dysplasia
Blasts 5-9%
No Auer rods

Refractory anaemia with excess of blasts –2 ( RAEB-2)

Cytopenias
Blasts 5-19 %
Auer rods
±
or
Blasts 5-19 %
monocytes  < 1x109/L

Unilineage or multilineage dysplasia
Blasts 10-19%
Auer rods
±

Myelodysplastic Syndrome unclassified (MDS-U)

Cytopenias
No or rare blasts
No Auer rods

Unilineage dysplasia: one myeloid cell line
Blasts <5%
No Auer rods

MDS associated with isolated del (5q)

Anemia
Usually normal or increased platelet count
< 5% blasts

Normal to increased megakaryocytes with hypolobated nuclei
< 5% blasts
isolated del (5q) cytogenetic abnormality
No Auer Rods

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