French American British (FAB) morphological classification of childhood lymphoblastic leukaemia and its clinical importance

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Abstract

As part of the Medical Research Council Leukaemia Trial UKALL VIII, 738 unselected children with acute lymphoblastic leukaemia (ALL) had the morphology of their marrow blast cells reviewed by a panel of three haematologists. Ninety four (13%) showed appearances classifiable as type L2 by the French American and British (FAB) cooperative group's criteria, five (0.7%) were typed L3, and the remaining 639 (86%) as L1. Disregarding the patients classified as L3, those with the L2 variant showed an inferior disease free survival to that of the remainder (p < 0.01), and more of them failed to remit after receiving ''standard'' remission induction treatment (p < 0.01). They included an excess of older children (p < 0.01) with less profound marrow failure at diagnosis, and fewer of them expressed the common ALL antigen (p = 0.05). There was no association between L2 morphology and the diagnostic white cell count, sex, or the presence of a mediastinal mass. These findings confirm earlier reports that FAB L2 ALL is associated with a poor prognosis and that it occurs more commonly in older children. The high remission failure rate is a recent observation and indicates that alternative early treatment may be appropriate for such patients.

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Lilleyman, J. S., Hann, I. M., Stevens, R. F., Eden, O. B., & Richards, S. M. (1986). French American British (FAB) morphological classification of childhood lymphoblastic leukaemia and its clinical importance. Journal of Clinical Pathology. BMJ Publishing Group. https://doi.org/10.1136/jcp.39.9.998

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