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March 2002
  12th March:   revised HMDS diagnostic criteria for myeloproliferative and lymphoproliferative disorders following publication in late 2001 of the World Health Organisation Classification of Tumours of the Haematopoietic and Lymphoid Tissues.
 

 

Classification of the Haematological Malignancies: Diagnostic Criteria

There are over 50 subtypes of haematological malignancy currently recognised, displaying a wide range of clinical presentation, degree of malignancy and responsiveness to treatment. The World Health Organisation Classification of Tumours of the Haematopoietic and Lymphoid Tissues, published in 2001, [Jaffe ES, Harris NL, Stein H, Vardiman JW. Tumours of Haematopoietic and Lymphoid Tissues IARC Press Lyon 2001] is the latest in a long line of classifications of haematological malignancy. As a direct descendant of the REAL (Revised European and American Lymphoma) classification introduced in the mid-1990's it adopts a similar approach to define entities based on combinations of morphology, immunophenotype, genetic abnormalities and clinical features. This differs from the predominately morphological approach seen in previous classifications (FAB and Kiel).

Reproduced below is the standard operating procedure for the laboratory diagnosis of leukaemia and lymphoma used in HMDS (current revision 10th March 2003). This extensive revision of the previous SOP was undertaken in response to the publication of the WHO classification, broadly following the diagnostic categories set out therein, with the exception of a few entities where the diagnostic criteria were felt to be too imprecise or showed significant overlap with other entities.

The individual diagnostic criteria have been chosen with the aim of ensuring high levels of diagnostic accuracy and reproducibility. In most cases this is achieved by ensuring the consistency of results across a range of independent diagnostic techniques. In a number of cases more stringent diagnostic criteria are used than those set out in the WHO classification. Emphasis has also been placed on the use of cellular prognostic factors that are likely to make an increasing impact on routine clinical practice.

The use of terminology and diagnostic criteria is subject to internal audit within the laboratory.

Tumours of Precursor Lymphoid Cells

  • Precursor B-lymphoblastic Leukaemia
  • Precursor T-lymphoblastic Leukaemia

Tumours of Mature Peripheral B-cells

  • Follicular Lymphoma
  • Diffuse Large B-cell Lymphoma
  • Burkitt Lymphoma
  • B-cell Chronic Lymphocytic Leukaemia
  • Mantle Cell Lymphoma
  • Systemic Marginal Zone Lymphoma
  • Extranodal Marginal Zone Lymphoma
  • Hairy Cell Leukaemia
  • Multiple Myeloma and Associated Disorders
  • Hodgkin Lymphoma
    • Classical Hodgkin Lymphoma
    • Nodular Lymphocyte Predominant Hodgkin Lymphoma

Tumours of Mature Peripheral T-cells

  • Angioimmunoblastic T-cell Lymphoma
  • Anaplastic T-cell Lymphoma
  • Peripheral T-cell Lymphoma, Common (Unspecified)
  • Enteropathy Type T-cell Lymphoma
  • Cutaneous T-cell Lymphoproliferative Disorders
    • Mycosis Fungoides / Sezary Syndrome
    • Primary Cutaneous CD30-positive T-cell Lymphoproliferative Disorders
    • Other Cutaneous T-cell Lymphomas
  • T-cell Prolymphocytic Leukaemia
  • Large Granular Lymphocytosis
  • Adult T-cell Leukaemia/Lymphoma (ATLL)

Myeloproliferative Disorders

  • Acute Myeloid Leukaemia
  • Acute Promyelocytic Leukaemia
  • Myelodysplastic Syndrome
  • Myelodysplastic/Myeloproliferative Disorders
    • Chronic Myelomonocytic Leukaemia
    • Juvenile Myelomonocytic Leukaemia
  • Chronic Myeloid Leukaemia
  • Chronic Myeloproliferative Disorders
  • Acute Myelofibrosis
  • Hypereosinophilic Syndrome

Other Disorders

  • Paroxysmal Nocturnal Haemoglobinuria
  • Aplastic Anaemia
  • Metastatic Tumours
  • Neuroblastoma, Rhabdomyosarcoma, Ewing's and PNET

Laboratory Investigation Protocols

  • Flow Cytometry Panels
  • Immunocytochemistry Panels
  • Fluorescent in situ Hybridisation
  • Summary Tables