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ACUTE MYELOID LEUKEMIA

The evolving nosology of myeloid neoplasms: the semi-centennial of the 1976 French-American-British classification

Leukemia volume 39, pages 2603–2609 (2025)Cite this article

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Abstract

The year 2026 marks the semi-centennial of the first iteration of the classification schema for myeloid neoplasms, namely the 1976 French-American-British (FAB) classification created by John M. Bennett and colleagues. The FAB classification of acute leukemia formed the biological framework of our current understanding of myeloid neoplasia. Reflecting from this historical lens, we have seen remarkable advances in diagnostics, prognostication, and therapeutics over the decades. Concerted efforts from various consensus groups have paved the way for these advances. Herein, we perform a historical analysis of the evolution of the nosology of myeloid neoplasms over the past 50 years, beginning with the landmark 1976 FAB classification. We discuss how the new nosology of myeloid neoplasms has been inspired by the widespread availability of next-generation sequencing technology as a critical adjunct to classical morphological assessment. We discuss evidence in support of a conceptual framework for categorizing myeloid neoplasms based on ontogeny, beginning from clonal hematopoiesis of indeterminate potential (CHIP). We review the foundational definitions of CHIP, including parallels with Darwinism at the cellular level, and the relevance of incorporation of precursor conditions into the most recent disease classification of myeloid neoplasms. We shed light onto patient-focused practical implications of classification schema, with emphasis on mutation-adapted therapeutic strategies. Finally, we discuss how emerging techniques such as single-cell sequencing and multi-omics may integrate into future revisions.

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Fig. 1: History of classification schema for myeloid neoplasms, beginning with the initial 1976 FAB classification and ending with the 2022 WHO classification.
Fig. 2: Framework for diagnosing of myeloid neoplasms over the past 50 years.
Fig. 3: Paradigm for multi-omic integration toward future revisions of the myeloid neoplasm nosology.

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Authors and Affiliations

  1. Dept. of Medicine – Division of Hematology/Oncology, UMass Memorial Medical Center, UMass Chan Medical School, Worcester, MA, USA

    Shyam A. Patel

  2. Center for Clinical and Translational Science, UMass Chan Medical School, Worcester, MA, USA

    Shyam A. Patel

  3. Cancer Biology Program, Morningside Graduate School of Biomedical Sciences, UMass Chan Medical School, Worcester, MA, USA

    Shyam A. Patel

  4. Dept. of Pathology and Laboratory Medicine, James P. Wilmot Comprehensive Cancer Center, University of Rochester Medical Center, Rochester, NY, USA

    John M. Bennett

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  1. Shyam A. Patel
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  2. John M. Bennett
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SAP: conception/design, manuscript writing, final approval of manuscript; JMB: supervision, critical review; final approval of manuscript.

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Correspondence to Shyam A. Patel.

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Competing interests

SAP served on the Acute Myeloid Leukemia Advisory Board and Myelodysplastic Syndromes Advisory Board for Bristol-Myers Squibb, the Acute Leukemia Advisory Board for Syndax, and the Multiple Myeloma Advisory Board for Pfizer; received travel support for the 2024 Aplastic Anemia and MDS International Foundation (AAMDSIF) conference; and received funding from UMass Dept. of Medicine to establish the CHIP Clinic (www.umassmed.edu/chip-clinic). JMB declares no conflicts of interest.

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Patel, S.A., Bennett, J.M. The evolving nosology of myeloid neoplasms: the semi-centennial of the 1976 French-American-British classification. Leukemia 39, 2603–2609 (2025). https://doi.org/10.1038/s41375-025-02746-9

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