Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology

Abstract

Context.-A complete diagnosis of acute leukemia requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping and karyotype analysis, and often, molecular genetic testing. Although many aspects of the workup for acute leukemia are well accepted, few guidelines have addressed the different aspects of the diagnostic evaluation of samples from patients suspected to have acute leukemia.Objective.-To develop a guideline for treating physicians and pathologists involved in the diagnostic and prognostic evaluation of new acute leukemia samples, including acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage.Design.-The College of American Pathologists and the American Society of Hematology convened a panel of experts in hematology and hematopathology to develop recommendations. A systematic evidence review was conducted to address 6 key questions. Recommendations were derived from strength of evidence, feedback received during the public comment period, and expert panel consensus.Results.-Twenty-seven guideline statements were established, which ranged from recommendations on what clinical and laboratory information should be available as part of the diagnostic and prognostic evaluation of acute leukemia samples to what types of testing should be performed routinely, with recommendations on where such testing should be performed and how the results should be reported.Conclusions.-The guideline provides a framework for the multiple steps, including laboratory testing, in the evaluation of acute leukemia samples. Some aspects of the guideline, especially molecular genetic testing in acute leukemia, are rapidly changing with new supportive literature, which will require on-going updates for the guideline to remain relevant.

A new highly sensitive real-time quantitative-PCR method for detection of BCR-ABL1 to monitor minimal residual disease in chronic myeloid leukemia after discontinuation of imatinib

“…Detection of low levels of BCR-ABL1 fusion transcripts to monitor MRD must be performed quickly, efficiently, and at a reasonable cost (27). Currently, several commercial kits using IS are available (22, 28); however, these are designed to test large-scale samples in commercial laboratories, rather than for hospital laboratories, in which relatively small numbers of samples are examined.…”

Myelodysplastisches Syndrom, akute Leukämie und Stammzelltransplantation

“…Because of similarities with rheumatic inflammatory diseases, manifestations and treatment of graft versus host disease (GvHD) are also included. Gerade die Einteilung der AML hat sich in den letzten Jahrzehnten dramatisch verändert [14]. Von der FAB-Klassifikation [15] mit ihrer M1-bis M6-Einteilung ist praktisch nur mehr das Konzept der akuten Promyelozytenleukämie (APL), der früheren AML M3, übrig geblieben, das sich durch häufig dramatische Gerinnungskomplikationen in der Frühphase unterscheidet.…”

Primary and Secondary Central Nervous System Involvement in Acute Myeloid Leukemia

“…The origins of Acute Myeloid Leukemia (AML) lie in precursor tumour-transformed hematopoietic cells, which lead to clonal proliferation and the accumulation of morphologically and functionally immature blast cells [1][2][3][4][5]. AML rarely invades areas other than the bone marrow, but in such instances, the most commonly afflicted organs are soft tissues, lymphatic tissues, and skin [6][7][8][9].…”