Ann Lab Med 2019; 39(3): 311-316  https://doi.org/10.3343/alm.2019.39.3.311
Reclassification of Acute Myeloid Leukemia According to the 2016 WHO Classification
Jin Jung, M.D.1*, Byung-Sik Cho, M.D.2,3*, Hee-Je Kim, M.D.2,3, Eunhee Han, M.D.1,4, Woori Jang, M.D.1,4, Kyungja Han, M.D.1, Jae-Wook Lee, M.D.5, Nack-Gyun Chung, M.D.5, Bin Cho, M.D.5, Myungshin Kim , M.D.1,4, and Yonggoo Kim , M.D.1,4
1Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea; 2Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; 3Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea; 4Catholic Genetic Laboratory Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; 5Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
Corresponding author: Myungshin Kim, M.D. https://orcid.org/0000-0001-8632-0168
Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: +82-2-2258-1645
Fax: +82-2-2258-1719
E-mail: microkim@catholic.ac.kr
Yonggoo Kim, M.D. https://orcid.org/0000-0003-2808-3795
Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: +82-2-2258-1642
Fax: +82-2-2258-1719
E-mail: yonggoo@catholic.ac.kr
Received: May 21, 2018; Revised: October 8, 2018; Accepted: December 19, 2018; Published online: May 1, 2019.
© Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
We reviewed our leukemia database to reclassify 610 patients previously diagnosed as having acute myeloid leukemia (AML) according to the updated 2016 WHO classification. Nine patients were categorized as having myelodysplastic syndrome and myeloid neoplasms with germline predisposition. AML with recurrent genetic abnormalities accounted for 57.4% (345/601) of the patients under the 2016 WHO classification. AML with mutated NPM1 was the most common form (16.5%), with the majority associated with monocytic differentiation (63.6%). AML with double CEBPA mutations accounted for 8.3% of these cases, and the majority were previously diagnosed as AML with/without maturation (78.0%). These newly classified mutations were mutually exclusive without overlapping with other forms of AML with recurrent genetic abnormalities. AML with mutated NPM1 and AML with myelodysplasia-related changes comprised the oldest patients, whereas AML with RUNX1-RUNX1T1 included the youngest patients. The leukocyte count was highest in AML with mutated NPM1, and the percentage of peripheral blood blasts was the highest in AML with double CEBPA mutations. Our results indicate that implementation of the 2016 WHO classification of AML would not pose major difficulties in clinical practice. Hematopathologists should review and prepare genetic tests for the new classification, according to their clinical laboratory conditions.
Keywords: 2016 WHO classification, Acute myeloid leukemia, NPM1, CEBPA



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