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{| class="wikitable" style="border-style: solid; border-width: 5px; color:black" |colspan="1" style = "font-size:90%; color:black; background:#bcd4e6"|'''Mixed Pheno..."

2024-01-09T13:28:03Z

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|colspan="1" style = "font-size:90%; color:black; background:#bcd4e6"|'''Mixed Phenotype Acute Leukaemia (MPAL): basics'''
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<span style="font-size:90%;">MPAL requires a diagnosis of acute leukaemia (>20% blast cells) but in which differentiation does not occur along a single lineage. This diagnosis is uncommon (2-3% of acute leukaemia).</span>

<span style="font-size:90%;">Flow cytometry provides initial evidence of MPAL. However conclusions may subsequently be modified (e.g. by results of immunohistochemistry, cytogenetics, or genetics). It is important that the provisional nature of flow cytometry assignment of MPAL is acknowledged.</br></br></span>

<span style="font-size:90%;">'''Types and frequency of MPAL types'''</span></br>
<span style="font-size:90%;">(1) MPAL with features of Myeloid and B-lineage (MPAL M/B) (>50% cases)</br></span>
<span style="font-size:90%;">(2) MPAL with features of Myeloid and T-lineage (MPAL M/T) (>33% cases)</br></span>
<span style="font-size:90%;">(3) MPAL with combinations: MPAL B/T (rare) or B/T/M (very rare)</br></span></br>
<span style="font-size:90%;">Following further analysis cases may be assigned additionally as:</span></br>
:<span style="font-size:90%;">MPAL with t(9;22) (q34.1;q11.2); BCR-ABL1;</span></br>
:<span style="font-size:90%;">MPAL with t(v;11q23.3); with KMT2A re-arrangement</span></br>

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<span style="font-size:90%;">The blast population may express markers of the two separate lineages both on the same cell (bi-phenotypic pattern) in which case blast number must exceed 20%, alternatively the blast cells may have two lineages that co-exist (bi-lineal pattern) in which case the combined blast cell number must exceed 20%.</span>

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|colspan="1" style = "font-size:90%; color:black; background:#bcd4e6"|'''Mixed phenotype: diagnosis'''
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<span style="font-size:90%>To diagnose MPAL, the leukaemia should meet '''at least two of the three criteria''' below:
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!colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Criteria to assign myeloid lineage'''
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|colspan="2" style = "font-size:90%; color:black;"|The case has '''lineage-defining features''' of myeloid maturation. This allows myeloid lineage to be defined in MPAL</br>[[Flow Cytometry:Myeloid lineage assignment in MPAL|Click here to review criteria for myeloid lineage assignment based on lineage-defining features]]</br></br>'''Note:''' myeloid-associated lineage markers cannot be contribute to myeloid lineage assignment in MPAL.
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!colspan="2" style = "font-size:90%; color:black; background:#ddeee1"|'''Criteria to assign B-lymphoid lineage'''
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|colspan="2" style = "font-size:90%; color:black;"|The case has '''lineage-defining features''' of B-lymphoid maturation. This allows B-lymphoid lineage to be defined in MPAL</br>[[Flow Cytometry:B-lymphoid lineage assignment in MPAL|Click here to review criteria for B-lymphoid lineage assignment]]</br></br>'''Note''' Where T-lineage is also considered the diagnostic value of CD79A is reduced so should not be considered in the lineage assignment.
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|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |Criteria to assign T-lymphoid lineage
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|colspan="2" style = "font-size:90%; color:black;"|[[Flow Cytometry:T-Lymphoid lineage assignment|Click here to review criteria for T-lymphoid lineage assignment]]
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Consider also:
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Flow Cytometry:T-Lymphoid lineage assignment in MPAL - Revision history