Multiparameter Flow Cytometry Applications in the Diagnosis of Mixed Phenotype Acute Leukemia
(2019) In Cytometry Part B - Clinical Cytometry 96(3). p.183-194- Abstract
Mixed phenotype acute leukemias (MPALs) represent a rare subgroup of acute leukemias with a poor prognosis. Proper diagnosis and classification of MPAL is extremely important for patients' outcome. Morphology and flow cytometry recognize two types of MPAL: the “bilineal” MPAL with the coexistence of two blast populations of different lineage and truly “biphenotypic” MPAL coexpressing markers of more than one lineage in a homogenous blast population, respectively. The WHO 2008 classification further delineated three categories: associated with t(9;22)/BCR-ABL1 fusion gene, associated with KMT2A (mixed lineage leukemia) rearrangements, and nonotherwise specified. These categories remained unchanged in the WHO2016 update. Molecular studies... (More)
Mixed phenotype acute leukemias (MPALs) represent a rare subgroup of acute leukemias with a poor prognosis. Proper diagnosis and classification of MPAL is extremely important for patients' outcome. Morphology and flow cytometry recognize two types of MPAL: the “bilineal” MPAL with the coexistence of two blast populations of different lineage and truly “biphenotypic” MPAL coexpressing markers of more than one lineage in a homogenous blast population, respectively. The WHO 2008 classification further delineated three categories: associated with t(9;22)/BCR-ABL1 fusion gene, associated with KMT2A (mixed lineage leukemia) rearrangements, and nonotherwise specified. These categories remained unchanged in the WHO2016 update. Molecular studies have further underlined the heterogeneity of MPAL. In this review, rules for the correct assignment of acute leukemia to the MPAL category are discussed, including both flow cytometry and immunohistochemistry on bone marrow or other tissues biopsies. Comparison of the immunophenotypic classification proposals is provided outlining the explorations mandatory for definitive diagnosis. An extensive review of published data summarizes the reported cytogenetic and molecular anomalies. New developments in the understanding of the early stages of hematopoiesis provide clues to the possible etiopathology of these diseases. Finally, current treatment recommendations are summarized and referenced for clinical use, pointing out that allogeneic hematopoietic stem cell transplantation at an early stage should be considered (at least in adult patients).
(Less)
- author
- Porwit, Anna LU and Béné, Marie C.
- organization
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- ambiguous lineage, flow cytometry, leukemia, mixed phenotype
- in
- Cytometry Part B - Clinical Cytometry
- volume
- 96
- issue
- 3
- pages
- 183 - 194
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- scopus:85065169028
- pmid:31033213
- ISSN
- 1552-4949
- DOI
- 10.1002/cyto.b.21783
- language
- English
- LU publication?
- yes
- id
- 4f8bb26e-a7fd-4735-af6f-de4197709589
- date added to LUP
- 2019-05-22 09:35:47
- date last changed
- 2024-06-26 17:12:47
@article{4f8bb26e-a7fd-4735-af6f-de4197709589,
abstract = {{<p>Mixed phenotype acute leukemias (MPALs) represent a rare subgroup of acute leukemias with a poor prognosis. Proper diagnosis and classification of MPAL is extremely important for patients' outcome. Morphology and flow cytometry recognize two types of MPAL: the “bilineal” MPAL with the coexistence of two blast populations of different lineage and truly “biphenotypic” MPAL coexpressing markers of more than one lineage in a homogenous blast population, respectively. The WHO 2008 classification further delineated three categories: associated with t(9;22)/BCR-ABL1 fusion gene, associated with KMT2A (mixed lineage leukemia) rearrangements, and nonotherwise specified. These categories remained unchanged in the WHO2016 update. Molecular studies have further underlined the heterogeneity of MPAL. In this review, rules for the correct assignment of acute leukemia to the MPAL category are discussed, including both flow cytometry and immunohistochemistry on bone marrow or other tissues biopsies. Comparison of the immunophenotypic classification proposals is provided outlining the explorations mandatory for definitive diagnosis. An extensive review of published data summarizes the reported cytogenetic and molecular anomalies. New developments in the understanding of the early stages of hematopoiesis provide clues to the possible etiopathology of these diseases. Finally, current treatment recommendations are summarized and referenced for clinical use, pointing out that allogeneic hematopoietic stem cell transplantation at an early stage should be considered (at least in adult patients).</p>}},
author = {{Porwit, Anna and Béné, Marie C.}},
issn = {{1552-4949}},
keywords = {{ambiguous lineage; flow cytometry; leukemia; mixed phenotype}},
language = {{eng}},
number = {{3}},
pages = {{183--194}},
publisher = {{John Wiley & Sons Inc.}},
series = {{Cytometry Part B - Clinical Cytometry}},
title = {{Multiparameter Flow Cytometry Applications in the Diagnosis of Mixed Phenotype Acute Leukemia}},
url = {{http://dx.doi.org/10.1002/cyto.b.21783}},
doi = {{10.1002/cyto.b.21783}},
volume = {{96}},
year = {{2019}},
}