According to the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, what does acute myeloid leukemia (AML) with myelodysplasia-related changes (AML-MRC) encompass?

Answer

The revised 4th edition (2016/2017 update) of the World Health Organization (WHO) Classification of Tumours of Haematopoietic and Lymphoid Tissues has focused increased attention on genetic abnormalities to characterize and subclassify acute myeloid leukemia (AML), including AML with myelodysplasia-related changes (AML-MRC).^{[1, 2]}

AML-MRC encompasses the following:

AML arising in myelodysplastic syndrome (MDS) or in myelodysplastic/myeloproliferative neoplasm (MDS/MPN)
AML with MDS-related cytogenetic abnormalities
AML with multilineage dysplasia

This category of AML primarily occurs in elderly patients; it is rare in children. AML-MRC represents 25-35% of AML cases.^{[3, 4, 5, 6]}

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Media Gallery

Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). This image depicts dysgranulopoiesis: hypogranulosis.
Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). This image displays dysgranulopoiesis: vacuolization. Image courtesy of Rector and Visitors of the University of Virginia.
Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). Dysgranulopoiesis demonstrating Chediak-Higashi-like granules (arrow) is shown.
Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). Dyserythropoiesis is seen.
Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). The bone marrow core biopsy evaluation reveals dysmegakaryopoiesis with numerous small hypolobated megakaryocytes.
Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). Dysmegakaryopoiesis in the multinucleated form is noted.
Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). This image reveals a dysplastic promyelocyte with a cytoplasmic vacuole (left), blast (center), and dysplastic neutrophil with pseudo-Pelger-Huet anomaly and hypogranularity (right).
Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). Note the dysplastic neutrophil with large pseudo-Chediak-Higashi granules.
Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). A dysplastic red blood cell with budding nuclei (left) is seen with a monocyte (center), and a blast (right).
Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). Numerous dysplastic erythroid cells are seen, demonstrating nuclear budding, irregular nuclear contours, and multinucleation.
Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). A cluster of dysplastic megakaryocytes with small hypolobated nuclei is seen on a bone marrow aspirate smear preparation.
Pathology of Acute Myeloid Leukemia With Myelodysplasia-Related Changes (AML-MRC). Note the dysplastic neutrophil with large pseudo-Chediak-Higashi granules.

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According to the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, what does acute myeloid leukemia (AML) with myelodysplasia-related changes (AML-MRC) encompass?

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