Therapeutic decision making in BMT/SCT for acute myeloid leukemia

Classification of acute myeloid leukemia page 23 Cytochemical and immunohistochemical stains used for the classification of acute leukemia 25 Cytochemical, cytogenetic, and immune phenotype features of AML 26 Other variants 26 Acute undifferentiated leukemia 26 Acute mixed lineage leukemia 26 Prognostic factors 27 Results with conventional therapy in adults 27 Results with allogeneic and autologous transplant 31 Indications for transplant 36 9 of 10 HLA-identical family member transplant 37 Pretransplant workup 37 Monitoring posttransplant 38 Treatment algorithm for acute myeloid leukemia (AML) 38 Induction 38 Consolidation in remission 38 Relapsed or refractory AML 38 Further reading 39 Classification of acute myeloid leukemia Cytochemical and immunohistochemical stains used for the classification of acute leukemia Myeloperoxidase (MPO), an enzyme found in the primary (azurophilic) granules of cells of the granulocytic and monocytic series, is vital for distinguishing between lymphoid leukemia and myeloid leukemia. The granules are stained a dark blue to dark brown color when free oxygen liberated by the peroxidase reacts to change a benzidine dye from its clear state to a colored state. Nonspecific esterase (NSE), prominent in monocytes and their precursors, employs α-naphthyl butyrate or α-naphthyl acetate, following pretreatment with sodium fluoride, as substrate for enzymatic cleavage of the naphthyl group, which is then reacted with a diazo dye. Although staining is prominent in the monocytic series, there can be weak staining in some acute lymphoblastic leukemia (ALL) cases and in some cases of AML-M3. The periodic acid–Schiff (PAS) reaction depends on the liberation of carbohydrate radicals, which are oxidized to aldehydes and then reacted with Schiff reagent