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Morphological metamorphosis in relapsing lymphoblastic leukemia.

J S Lilleyman, J A Britton, B J Laycock

    Journal of Clinical Pathology
    |January 1, 1981
    PubMed
    Summary
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    Most lymphoblastic leukemia (ALL) patients initially classified as French-American-British (FAB) L1 change to FAB L2 during treatment. This FAB L2 subtype of ALL indicates a more aggressive disease and potential treatment resistance.

    Area of Science:

    • Hematology
    • Oncology
    • Cell Biology

    Background:

    • Lymphoblastic leukemia (ALL) is a significant hematologic malignancy.
    • Morphological classification of ALL is crucial for prognosis and treatment planning.
    • The French-American-British (FAB) classification system categorizes ALL subtypes based on blast cell morphology.

    Purpose of the Study:

    • To investigate changes in blast cell morphology during the course of lymphoblastic leukemia (ALL).
    • To determine the relationship between FAB L1 and FAB L2 subtypes in ALL.
    • To assess the clinical implications of morphological changes in ALL.

    Main Methods:

    • Retrospective analysis of bone marrow morphology in 33 ALL patients.
    • Blind classification of blast cell morphology according to FAB criteria at diagnosis and relapse.

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  • Correlation of morphological subtypes with T-cell markers.

    • Main Results:

    • A significant shift from FAB L1 to FAB L2 morphology was observed in 79% of patients (19/24) during disease progression (p < 0.001).
    • No reverse transformation from FAB L2 to FAB L1 was noted.
    • Patients retaining FAB L1 morphology included those with T-cell markers; one FAB L3 patient remained consistent.

    Conclusions:

    • FAB L2 ALL frequently develops from FAB L1 ALL, suggesting an aggressive evolution.
    • The emergence of FAB L2 morphology may indicate treatment resistance.
    • Morphological shifts in ALL provide insights into disease behavior and prognosis.