Mixed-phenotype acute leukemia characteristics: first report from Iran

Abstract

Mixed-phenotype acute leukemia (MPAL) is the infrequent type of acute leukemia characterized by immunophenotypic and/or cytochemical features of both lineages, but the diagnosis of this disease still is a challenge. In this study, we analyzed immunophenotyping, cytochemistry and frequency of MPAL patients to better diagnosis of MPAL characteristics according to WHO 2016 criteria for the first time in Iran. In this retrospective study, 27 patients were diagnosed as MPAL based on WHO 2016 criteria during 2014-2017. Flow cytometric immunophenotyping was performed on PB and BM samples evaluation of different CD marker expressions in MPAL subsets. RT-PCR was performed for the analyses of BCR/ABL1 fusion in MPAL subsets. Among 27 cases, (70.4%) 19 cases were B + My, (22.22%) 6 cases were T + My, and 2 cases (7.40%) were B + T + My. CD34, CD19, HLA-DR, TdT, CD22, iMPO were positive in majority of B + My cases. CD45, iMPO, iCD3, CD7, CD2 and CD5 were positive in majority of T + My cases. HLA-DR, TdT, CD10, CD22, iCD79a, iMPO, CD45, iCD3, CD7, CD3, CD2, CD5 were positive in majority of B + T + My cases. BCR/ABL1 fusion was positive for 3 cases (11.1%) of p190 fusion and 2 cases (7.4%) of p210 fusion in B + My cases. WHO 2016 criteria are the current standard for diagnosing MPAL. Also, evaluation of TdT, CD2, CD5, CD7 expressions by flow cytometry in EGIL criteria is useful for the better diagnosis of MPAL subsets. In addition, evaluation of BCR/ABL1 and MLL rearrangements in patients should be part of standard work-up in MPAL.

Mixed phenotype acute leukemia: Biological profile, clinical characteristic and treatment outcomes: Report of the population‐based study

“…However, literature data on prevalence of MPAL between gender distribution are not clear, as Deffis‐Court et al 22 and Matutes et al 10 showed that MPAL cases were more frequent in males (63%) and females (68%), respectively. In our data and similarly to other studies, there was no significant difference in patients’ and clinical disease characteristics between MPAL subsets 20 . However, we found that despite comparable rate of CR in T/myeloid and B/myeloid leukemia, the pEFS was significantly better within patients with T/myeloid phenotype ( P = .047).…”

“…The incidence of BCR/ABL1 -positive disease is reported to be higher in adults (15%-30%) than in pediatric patients (4%-16%), especially in B/myeloid phenotype, while MLL rearrangements are reported more often in children (11%-12%) compared to adults (4%-8%). 5,11,[18][19][20] As there is a large number of publications indicating the benefits of TKIs in the treatment of MPAL patients with BCR/ABL1 fusion, 11,20,21 evaluation of BCR/ABL1 is a standard way for better diagnosis in patients with MPAL, especially that this is a population with higher rates of this fusion than other childhood AL. 20 In our study, MPAL patients included 66.7% males and 33.3%…”

“…5,11,[18][19][20] As there is a large number of publications indicating the benefits of TKIs in the treatment of MPAL patients with BCR/ABL1 fusion, 11,20,21 evaluation of BCR/ABL1 is a standard way for better diagnosis in patients with MPAL, especially that this is a population with higher rates of this fusion than other childhood AL. 20 In our study, MPAL patients included 66.7% males and 33.3%…”

Frequency of Cytogenetic Findings and its Effect on the Outcome of Pediatric Acute Lymphoblastic Leukemia

“…Cancer is an uncontrolled growth of the body’s cells, the most common form of which is in children as hematologic malignancies, accounting for 44% of the cancers diagnosed in children (33% leukemia and 11% lymphoma) (1). Acute Lymphoblastic Leukemia (ALL) accounts for about 75% of leukemia cases, and is considered as a clonal malignancy of bone marrow in which early lymphoid precursors proliferates, leading to replacement of them with normal hematopoietic cells in the bone marrow (2).…”

Análise de métodos imunofenotípicos no diagnóstico precoce de leucemias agudas

“…Além disso, a avaliação de rearranjos de BCR, ABL1 e MLL também fazem parte da investigação desse tipo de leucemia. (Poopak, B. et al, 2018) Segundo Teke et al (2017) a LMA, a expressão do antígeno TdT demonstra um mau prognóstico que tem efeito na sobrevida do paciente. Os antígenos na superfície dos blastos não afetam o prognóstico de LMA isoladamente.…”