Cytoplasmic vacuoles, which are a morphological feature of dysplasia, can be observed under a microscope at initial diagnosis. Recently, this typical morphological feature has been found to be associated with impaired survival. To investigate the clinical significance of the grading of blasts with vacuoles in acute myeloid leukemia (AML), we retrospectively studied 152 patients newly diagnosed with non-M3 AML. The patients were categorized into three groups according to the percentage of blasts with vacuoles (>20 %, 11–20 %, 0–10 %). A high percentage of blasts with vacuoles (>20 %) was positively associated with the European Leukemia Net (2017-ELN) high-risk AML, a complex karyotype, TP53 and IDH1/2 mutations, and CD71 expression and negatively associated with the ELN low-risk category. Importantly, patients who had a higher percentage of blasts with vacuoles had a lower complete remission rate in response to first-cycle induction chemotherapy. The overall survival and event-free survival of patients who had a higher percentage of blasts with vacuoles were significantly shorter. Moreover, multivariate analysis showed that blast vacuolization was an independent high prognostic factor for AML. In conclusion, a higher percentage of leukemic blasts with vacuoles predicts worse outcomes in AML and may have potential as a prognostic marker.

细胞质空泡是发育不良的形态特征，初诊时可在显微镜下观察到。最近，发现这种典型的形态特征与生存受损有关。为了研究急性髓系白血病 (AML) 中空泡原始细胞分级的临床意义，我们回顾性研究了 152 名新诊断为非 M3 AML 的患者。根据带有空泡的原始细胞的百分比（> 20 %、11-20 %、0-10 %）将患者分为三组。高比例的空泡母细胞 (>20%) 与欧洲白血病网 (2017-ELN) 高危 AML、复杂核型、TP53 和 IDH1/2 突变以及 CD71 表达呈正相关，与 ELN 呈负相关低风险类别。重要的，具有空泡原始细胞比例较高的患者对第一周期诱导化疗的完全缓解率较低。具有更高比例的空泡原始细胞的患者的总生存期和无事件生存期明显更短。此外，多变量分析表明原始细胞空泡化是 AML 的独立高预后因素。总之，具有空泡的白血病原始细胞的百分比较高预示着 AML 的预后较差，并且可能具有作为预后标志物的潜力。多变量分析表明原始细胞空泡化是 AML 的一个独立的高预后因素。总之，具有空泡的白血病原始细胞的百分比较高预示着 AML 的预后较差，并且可能具有作为预后标志物的潜力。多变量分析表明原始细胞空泡化是 AML 的一个独立的高预后因素。总之，具有空泡的白血病原始细胞的百分比较高预示着 AML 的预后较差，并且可能具有作为预后标志物的潜力。