A review of AML classification: a single institution experience in a developing country

This study reviewed the distribution of de novo adult acute myeloid leukemia (AML) subtypes classified by both French–American–British (FAB) and World Health Organization (WHO) classifications in Malay patients. We have retrospectively analyzed 135 patients with de novo AML diagnosed in Hospital Universiti Sains Malaysia (HUSM) over the past 10 years. One hundred and thirty cases were classified according to the FAB classification and only 80 by the WHO. Majority of them (86.7 %) presented at the age between 15 and 59 years and minority presented in advance age 60 years and above. For the FAB classification, M2 and M4 subtypes were the commonest (21.5 %) followed by M3 (17.0 %), M5 (16.3 %), M1 and M6 (7.4 %), and M7 (3.7 %) and the least number of patients was M0 (1.5 %). The WHO classification identified 30 (37.5 %) cases as AML with recurrent cytogenetic abnormalities, 43 (53.7 %) cases as AML not otherwise specified (NOS), and 7 (8.75 %) cases as AML with myelodysplasia (MDS)-related changes. The most common genetic feature in AML with recurrent cytogenetic abnormalities was t(15;17)/PML/RARA, followed by t(8;21)/AML1/ETO and inv(16)/CBF/MYH11. We concluded that the classification according to the FAB is still widely used taking into consideration the various limitations especially in a developing country. At the same time, we have progressed to incorporate genetic data in our attempt to stratify patients for the purpose of patients’ management.