WHO classification of
myeloid neoplasms
- The myeloproliferative neoplasm (MPNs),
including the myeloid and lymphoid neoplasms with eosinophilia and
abnormalities of PDGFRA, PDGFRB, and FGFRA
- The acute myelogenous leukemia (AML)
- The myelodysplastic syndromes (MDS)
- The MDS/ MPN syndromes [1,2]
Classification of
lymphoid neoplasms
WHO classification of precursor lymphoid
neoplasms [2]
- B lymphoblastic leukemia/lymphoma
- B lymphoblastic leukaemia/lymphoma, NOS
- B lymphoblastic leukaemia/lymphoma with
recurrent genetic abnormalities
- B lymphoblastic leukaemia/lymphoma with
(9;22)(q34;q11.2);BCR-ABL1
- B lymphoblastic leukaemia/lymphoma with
t(v11q23);MLL rearranged
- B lymphoblastic leukaemia/lymphoma with
t(12;21)(p13;q22) TEL-AML1 (ETV6-RUNX1)
- B lymphoblastic leukaemia/lymphoma with
hyperdiploidy
- B lymphoblastic leukaemia/lymphoma with
hypodiploidy
- B lymphoblastic leukaemia/lymphoma with
t(5;14)(q31;q32) IL3-IGH
- B lymphoblastic leukaemia/lymphoma with
t(1;19)(q23;p13.3);TCF3-PBX1
- T lymphoblastic leukaemia/lymphoma
Classical hodgkin
lymphoma
- Nodular sclerosis classical Hodgkin
lymphoma.
- Classical Hodgkin lymphoma
- Lymphoticyte rich classical Hodgkin
lymphoma.
- Mixed cellularity classical Hodgkin
lymphoma.
- Lymphocyte – depleted classical Hodgkin
lymphoma [1,2].
WHO classification of
Mature B-Cell Neoplasms
- Chronic lymphotic leukemia / small lymphocytic lymphoma
- B-cell prolymphocytic leukemia
- Splenic marginal zone lymphoma
- hairy cell leukemia
- Splenic lymphoma
- Splenic diffuse red pulp small B-cell lymphoma
- Hairy cell leukemia variant
- lymphoplasmacytic lymphoma
- weldenstrom macroglobulinemia
- ?Heavy chain disease
- plasma cell myloma
- solitary plasmacytoma of bone
- Extraosseous plasmacytoma
- Extranodal marginal zone lymphoma of MALT lymphoma
- Nodal marginal zone lymphoma
- pediatric nodal marginal zone lymphoma
- Follicular lymphoma
- pediatric folicular lymphoma
- Primary cutaneous follicle center lymphoma
- Mantle cell lymphoma
- DLBCL, NOS
- Tcell/histiocyte- rich large B-cell lymphoma
- primary DLBCL of the CNS
- Primary cutaneous DLBCL , leg type
- EBV-positive DLBCL of the elderly
- DLBCL associated with chronic inflammation
- lymphomatoid granulomatosis
- primary mediastinal (thymic) large B-cell lymphoma
- intravascular large B-cell lymphoma
- ALK – Positive large B-cell lymphoma
- plasmablastic lymphoma
- Large B-cell lymphoma arising in HHV8-associated multicentric castleman disease
- Primary effusion lymphoma
- B-cell lymphoma unclassifiable with feature intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma
- Burkitt lymphoma
- B-cell lymphoma , unclassifiable , with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma
WHO Classification?of?Mature?T-Cell?and?NK-Cell?Neoplasms
- T-cell prolymphocytic leukemia
- T- cell large granular lymphocytic leukemia
- chronic lymphoproliferative disorder of NK cells
- aggressive NK cell leukemia
- systemic EBV-positive T-cell lymphoproliferative disease of childhood
- hydroa vacciniforme – like lymphoma
- adult T-cell leukemia
- Extranodal NK/Tcell lymphoma , nasal type
- Enteropathy associated T-cell lymphoma
- Subcutaneous panniculitis – like T-cell lymphoma
- Mycosis fungoides
- Sezary syndrome
- Primary cataneous CD 30 T-cell lymphoproliferative disorders
- lymphomatoid papulosis
- primary cutaneous anaplastic large- cell lymphoma
- primary cutaneous T-cell lymphoma
- primary cutaneous aggressive epidermotropic CD8 cytotoxic T-cell lymphoma
- primary cutaneous small/ medium CD4 T-cell lymphoma
- peripheral T-cell lymphoma NOS
- Angioimmunoblastic T-cell lymphoma
- Anaplastic large –cell lymphoma ALK +ve
- Anaplastic large-cell lymphoma ALK –ve
WHO Classification of
Histiocytic and Dendritic Cell Neoplasms
- Histiocytic
sarcoma
- Langerhans cell
histiocytosis
- Langerhans cell
sarcoma
- Interdigitating
dendritic cell sarcoma
- Follicular
dendritic cell sarcoma
- Fibroblastic
reticular cell tumor
- Intermediate
dendritic cell tumour
- Disseminated
juvenile xanthogranuloma
- Dendritic
and histiocytic neoplasms are hematologic malignancies that have distinct yet
variable clinical presentation, and together they make up less than 1% of the
neoplastic process of the lymph node or soft tissue [9].
However, the true prevalence of these disorders remains uncertain because many
have been recognized only recently. Several entities are recognized in the 2008
WHO classification of histiocytic and dendritic cell neoplasms.
Leukemia
Leukemia is a type of cancer
arising from any group of blood cancers that usually begin in the bone marrow
and result in high numbers of abnormal blood cells. Maybe white blood cells
(WBCs) leukemia resulting from malignant transformation of different types of
white blood cell precursors: lymphocytic
leukemia is an overproduction of lymphocytes, and myeloid leukemia is an overproduction
of myelocytes [10-12]. Leukemic
cells grow and divide uncontrollably, displacing healthy blood cells. This can
lead to serious problems such as anemia, bleeding, and infection [10-14].
Leukemia is the fifth leading cause of cancer death in the United States, and
the majority of cases occur in older adults. Leukemia is more common in men
than women and
in 2019, it is estimated that there will be 61,780 new cases of leukemia and an
estimated 22,840 people will die of this disease [15]. Leukemias are also
classified as either acute or chronic, depending on how quickly they
progress [7,10-12].
Acute Leukemias, if left
untreated, progress very rapidly, and without proper care the mortality rate is
extremely high within several months of diagnosis. However, appropriate
treatment can considerably improve prognosis and survival times for acute leukemia patients, and many can be
cured [10].
Chronic Leukemias, on the other
hand, may not cause any significant problems before diagnosis, though sometimes
they cause nonspecific symptoms such as weight loss, fatigue, or abdominal
pain. In many cases, abnormal blood cell counts found during routine blood work
in people without symptoms may prompt a physician to suspect leukemia, which
can be confirmed with further testing [10].
Researchers are making great headway in the battle against leukemia. Innovative
strategies including antibody-based therapies, interventions directed at
leukemia stem cells, and novel targeted agents have shown promise in
preliminary research and early clinical trials [16-20].
Moreover, evidence suggests that some integrative interventions may complement
conventional leukemia therapies. Several medicinal plants are excellent sources
of chemo preventive phytochemicals that have been shown to be active against
various leukemia cell lines, and some may modulate molecular targets known to
be involved in leukemia development and progression [21,22].
Types of leukemia
Leukemia is categorized on the
basis of how long the disease takes to progress and the kinds of blood cells
affected. Acute leukemia usually presents suddenly, and patients often develop
symptoms right away. Chronic leukemia progresses slowly and may not cause
symptoms for years [14,23].
Lymphocytic leukemia affects “T” and “B” white blood cells known as
lymphocytes. Myeloid leukemia affects myeloid cells, which go on to form white
blood cells other than lymphocytes (granulocytes and monocytes), red blood
cells, and platelets. Leukemia is classified into four main types: acute
lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid
leukemia (AML), and chronic myeloid leukemia (CML)
[14,23].
There are several other types of leukemia as well, such as hairy cell
leukemia, chronic neutrophilic leukemia, and acute megakaryocytic leukemia, but
these are relatively rare [24].
Rounded to the nearest 10; the numbers depict estimated new cases of leukemia
in the United States in 2014. Leukemias are further classified into subtypes
depending on the molecular and genetic characteristics of leukemia cells.
Correctly identifying the
properties of each patient’s cancer is critical
for prognosis and treatment [14,17,24,28].
Laboratory Tests of
Hematological Malignancies
Components in
the routine clinical evaluation of myeloid diseases current
- Accurate clinical history, including family history
and physical examination findings
- General laboratory findings, including CBC, and
other specific tests (e.g., EPO) when appropriate
- Evaluation of well-prepared and stained peripheral
blood smear with 200 cell differential count
- Review of BM aspirate, including iron stain, and 500
cell differential count
- Evaluation of H&E sections of BM biopsy of
sufficient length and reticulin stain
- Phenotyping studies, including cytochemical
reactions (nonspecific and specific esterase reactions and myeloperoxidase) and
flow cytometric analysis of peripheral blood or BM for phenotype of blasts or
other cells when appropriate
- Cytogenetic analysis, including karyotype, and FISH
for specific abnormalities when appropriate
- Single-nucleotide polymorphism array karyotyping
- Genetic analysis for particular genetic
rearrangements or mutations, including gene sequencing when appropriate
- Next-generation sequencing
- Potential Future Clinical Studies
- Gene expression arrays
- Genome-wide epigenetic studies
-
BM, Bone marrow; CBC, complete blood count; EPO,
erythropoietin; FISH, fluorescence in situ hybridization; H&E, hematoxylin
and eosin [1].
Related Studied
MOHP demonstrates in the 2018
report on 2011-2016 period there were 8515 cases of malignant neoplasm; the
third-highest percent was Leukemia were 9.1% about 775 cases, Lymphoma 6.2%
about 528 cases, and it was the fourth-highest in female malignancies with 5.3%
of 4705 female cases [29].
In
addition to the incidence of Malignancy in children’s ages, 18 years (yrs) and
less were 608 approximately 7.1% from the total malignant neoplasm; the percentage
of leukemia was 23.8%, and the highest percentage was Lymphoma 17.1% in
children [29]. On the other hand, the second leading cause of death according
to the report of MOHP for deaths was malignancy neoplasm; counted 805 death
about 10.6% of total causes. Furthermore the Mortality rate 36.8/100000 of the
population of in the end 2018; the percentage of deaths according age groups
1-less than 5yrs 5.3%, from 5- less than
20yrs 5.8%, from 20- less than 60yrs 16.7%
and the second-highest percent of total deaths in the age group more
than 60yrs 10.2% from the total 2956 deaths [30]. Finally, according to MOHP
report the shortage in the annual financial needs for laboratory expenses were
26.9% of the essential requirements
[29]. In India, a study by Sharique et al.,2016 evaluated the
frequencies of ALL, AML, CLL and CML, diagnosed in our hospital. Study also
aimed at calculating frequencies as per World Health Organization (WHO)
classified leukemia on the bone marrow studies and found that An upward trend
in incidence of leukemia with age was seen, although the acute leukemia’s were
more common in patients below 20 years of age. The total number of males who
participated in this study were 116[40.6%] while females were 170[59.4%].
Maximum patients were in the age group 21-30 years. The prevalence percentage
of leukemia seen in our study was more in the age group of 51-60 and 71-80
years. Males were seen to be afflicted more than females in all age groups. No
correlation between the gender of the patients and type of leukemia was seen on
applying Fischer Exact test. Acute leukemia show a greater prevalence in second
decade [8]. In Germany, across-sectional study was conducted to evaluate the
oral health of adult patients with newly diagnosed acute leukemia, the study
showed that Thirty-nine patients with leukemia (AML 26, ALL 13) and 38 HCs were
included. Oral mucosal findings were present in 62% of L compared to 0% of HC
patients, whereby gingival hyperplasia was the most detected finding.
Furthermore, a higher caries prevalence in leukemia patients was shown (D value
3.64 ± 3.98 vs. 0.72 ± 1.72, p < 0.01). The periodontal parameters were
poorer in leukemia patients. No substantial differences in microbiological
findings of selected bacteria were detected within L group and between Leukemia
and Healthy Control patients [6]. In
America, a study by Jorge et al .,2012
estimate the increasing prevalence and plateau prevalence of CML in future
years and found that On the basis of these calculations, the mortality ratio of
patients with CML compared with an
age-matched normal population was approximately 1.53. The estimated
prevalence of CML is approximately 70,000
in 2010, 112,000 in 2020, 144,000 in 2030, 167,000 in 2040, and 181,000
in 2050, when it will reach a near plateau
prevalence [31]. In India, Radha et al. 2014 conducted their study to
find out geographic pattern of leukemia and its distribution throughout the
Haryana and he observed that 51%
patients were suffering from acute forms of leukemia while 49% suffered from
chronic type. Leukemia was more frequently observed in adults. Male to female
ratio was 2:1 and majority of the patients (88.92%) belonged to six districts
(i.e. Rohtak, Jind, Bhiwani, Sonipat, Jhajjar, Hissar) [32]. Kyu-Won et al. study
presents the 2014 nationwide cancer statistics in Korea, including cancer
incidence, survival, prevalence, and mortality and he observed that in 2014, 217,057 and 76,611 Koreans were
newly diagnosed and died from cancer respectively. The ASRs for cancer
incidence and mortality in 2014 were 270.7 and 85.1 per 100,000, respectively.
The all-cancer incidence rate has increased significantly by 3.4% annually from
1999 to 2012, and started to decrease after 2012 (2012-2014; annual percent
change, –6.6%). However, overall cancer mortality has decreased 2.7% annually
since 2002. The 5-year relative survival rate for patients diagnosed with
cancer between 2010 and 2014 was 70.3%, an improvement from the 41.2% for
patients diagnosed between 1993 and [33]
(Figures 7-14).