Acute myeloblastic leukaemias in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

The diagnosis of AML requires the examination of peripheral blood and bone marrow specimens. The work-up of these specimens should include morphology, cytochemistry, immunophenotyping, cytogenetics and molecular genetics [chiefly polymerase chain reaction (PCR) and fluorescence in situ hybridisation (FISH) techniques]. See Table 1. Whilst historically sorted by the largely descriptive FrenchAmerican-British (FAB) criteria [1], AML are now classified according to the World Health Organisation (WHO) classification from 2001, revised in 2008 [2–4]. The WHO classification incorporates, in addition to morphological criteria, cytogenetic data, molecular genetics, immunophenotype data and clinical information into a diagnostic algorithm to delineate clinically significant disease entities. In the WHO classification the term ‘myeloid’ includes all cells belonging to the granulocytic, monocyte/macrophage, erythroid, megakaryocytic and mast cell lineage. The percentage of blast cells in the bone marrow is a practical tool for categorising myeloid neoplasms into AML or myelodysplastic syndromes (MDS), respectively, where myeloid neoplasms with more than 20% blasts in the peripheral blood or bone marrow are considered AML, either de novo, or having evolved from a pre-existing MDS. Blasts are defined using the criteria recently proposed by the International Working Group on Morphology of MDS. risk assessment and prognostic factors