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The last four decades have witnessed major transformations in the approach to the diagnostic work-up and therapeutics in the field of hematology. The identification of the Philadelphia chromosome in Chronic Myelogenous Leukemia has served as a prototype for diagnosis and subsequent monitoring of response. This discovery has led to the understanding of the pathogenesis and subsequent developments in therapeutic targeting the pathways. These principles have helped evolve therapeutic strategies aimed at molecular pathways in several disorders. Acute leukemias were classified based on morphology and cytochemistry supplemented by immunophenotyping, as proposed by the French–American–British (FAB) group. Following advances and greater access to immunophenotyping techniques and simultaneous refinements in cytogenetic methods, the MIC groups proposed the classification of acute leukemias incorporating morphology, immunologic typing and cytogenetic analysis. MIC–M classification granted recognition to molecular genetic information by formally incorporating it into the classification (Bain BJ, 1998). In 2001, the World Health Organization (WHO), in collaboration with the Society for Hematopathology and the European Association of Haematopathology, published a Classification of Tumors of the Hematopoietic and Lymphoid Tissues as part of its 3rd edition of the series, WHO Classification of Tumors (Jaffe ES et al, 2001). This classification system was a worldwide consensus classification system for hematological malignancies. It stratified neoplasms according to the lineage. Within each category distinct entities are defined based on morphology, immunophenotype, genetic features and clinical syndromes. The classification reflected a paradigm shift from previous schemes as for the first time, genetic information was incorporated. A revised classification was published in 2008 as the 4th edition of the WHO monograph series (Swerdlow SH et al, 2008). The revision incorporates new scientific and clinical information. Refined diagnostic criteria for previously described neoplasms and newly recognized distinct entities have been defined. The new classification defines 108 new diagnostic entities in hematopathology, including 50 new or provisional leukemia entries and also recognizes provisional entities that have a definite prognostic significance (Arber DA, 2010; Betz BL & Hess JL, 2010; Swerdlow SH et al, 2008).

Diagnostic Approach in Acute Myeloid Leukemias in Line with WHO 2008 Classification