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Cup-like acute myeloid leukemia: new disease or artificial phenomenon?

¹ First Medical Department and
² Institute of Pathology, Dresden University Hospital, Dresden;
³ University Hospital of Schleswig-Holstein, Campus Kiel, Department of Stem Cell and Immunotherapy, Kiel, Germany

Correspondence: Dr. Frank Kroschinsky, Medizinische Klinik und Poliklinik I, Universitätsklinikum der TU Dresden D-01307 Dresden, Fetscherstraβe 74 Germany. E-mail: kroschinsky{at}mk1.med.tu-dresden.de

We investigated cup-like nuclear morphology of acute myeloid leukemia blasts in 266 randomly selected patients and its association with hematologic findings, disease markers and outcome data. Cup-like acute myeloid leukemia was diagnosed in 55 patients (21%). It was associated with female sex, high white blood cell and blast cell counts, normal karyotype, and low CD34 and HLA-DR expression. Mutations of FLT3, NPM1 or both were detected in 84.9% compared with 58.1% in cases without this morphology (p=0.001). There was no influence on response to treatment or survival. Therefore, cup-like nuclear morphology is an indicator of normal karyotype and should guide more specific molecular analyses.

Key words: acute myeloid leukemia, morphology, cup-like, FLT3, NPM1.