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Mixed Phenotype Acute Leukemia, B/Myeloid with t(9;22): Diagnostic and Therapeutic Challenges

  • Namrata P. Awasthi
  • Poonam SinghEmail author
  • Narendra Agrawal
Correspondence
  • 13 Downloads

Dear Editor,

Mixed phenotype acute leukemia (MPAL) account for 4% of all cases of acute leukemia. Extensive immunophenotypic analysis is required for evaluation of these neoplasms, as morphologically distinct blast populations may not be evident [ 1]. The 2008/2016 WHO established strict criteria for diagnosis of MPAL, emphasizing assignment of myeloperoxidase for myeloid lineage, cytoplasmic CD3 for T lineage and CD19 and other B markers for B lineage (Table  1). WHO recognizes 2 distinct categories: MPAL with the t(9;22)(q34;q11)/ BCR- ABL1 and MPAL with t(v;11q23)/ MLL rearrangement. The remaining cases are designated as MPAL NOS (not otherwise specified).
Table 1

World Health Organization 2008/2016 criteria for mixed-phenotype blasts

Lineage

Markers

Myeloid

MPO (flow cytometry, immunohistochemistry, or enzyme cytochemistry) –OR

 

Monocytic differentiation (at least 2 of the following: NSE cytochemistry, CD11c, CD14, CD64, lysozyme)

T lineage

Strong cytoplasmic CD3

 

-OR

 

SurfaceCD3

B...

Notes

Author Contributions

NPA: Definition of intellectual content, Literature search, Data acquisition, Data analysis, Manuscript editing, Manuscript review, Guarantor; PS: Design, Definition of intellectual content, Literature search, Data analysis, Statistical analysis, Manuscript preparation, Manuscript review, Guarantor; NA: Definition of intellectual content, Clinical studies, Data acquisition, Manuscript editing, Manuscript review, Guarantor.

Compliance with Ethical Standards

Conflicting interest

The authors declare that they have no conflicting interest.

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Copyright information

© Indian Society of Hematology and Blood Transfusion 2018

Authors and Affiliations

  1. 1.Department of PathologyDr. Ram Manohar Lohia Institute of Medical SciencesLucknowIndia
  2. 2.Department of Lab MedicineSahara HospitalLucknowIndia
  3. 3.Rajiv Gandhi Cancer InstituteNew DelhiIndia

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