Lineage determination in mixed phenotype acute leukemia: Response to marcondes et al.

Fuda, Franklin; Chen, Weina

doi:10.1002/cyto.b.21159

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…1 Rarely, cases of otherwise typical B-ALL/lymphoma can express MPO by FCM or IHC (case 259) or least often by cytochemistry. [32][33][34]41 These cases are best classified and treated as B-ALL/lymphoma. In contrast, most MPAL cases show expression of other myeloid-associated markers and also are characterized by the presence of two or more subpopulations of blasts with slightly different immunophenotypes.…”

Section: Mpomentioning

confidence: 99%

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Acute Leukemias of Ambiguous Origin

Porwit

Béné

2015

American Journal of Clinical Pathology

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Section: Mpomentioning

confidence: 99%

“…[32][33][34] Previous FrenchAmerican-British group guidelines, based on cytochemistry, used 3% of MPO-positive blasts in BM smears as sufficient to call a leukemia MPO positive. 35,36 A threshold of 10% expression has been used by the EGIL group.…”

Section: Mpomentioning

confidence: 99%

Acute Leukemias of Ambiguous Origin

Porwit

Béné

2015

American Journal of Clinical Pathology

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“…MPO remains the most important marker for the myeloid lineage. Debates have occurred on the percentage and intensity of expression required to consider this marker positive . It is very important to establish which population is MPO‐positive, as sometimes remaining hematopoiesis may coexist with a blast population.…”

Section: Current Immunophenotypic Criteria By Flow Cytometrymentioning

confidence: 99%

Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia

Porwit

Béné²

2019

Cytometry Part B Clinical

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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). © 2019 International Clinical Cytometry Society

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“…Different MPO antibodies may have nonspecific and varied binding of leukemic blasts. 3,[14][15][16] In the aforementioned studies on B-ALL isoMPO and B/myeloid MPAL isoMPO and our study, a monoclonal MPO antibody (8E6) has been used, which would decrease antibody variability.…”

Section: Discussionmentioning

confidence: 99%

Adult mixed phenotype acute leukemia (MPAL): B/myeloid MPAL^isoMPO is distinct from other MPAL subtypes

Weinberg

Dennis

Zia

et al. 2022

Int J Lab Hematology

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Introduction: Myeloperoxidase (MPO) is considered a specific marker of myeloid/ non-monocytic lineage in the diagnosis of mixed phenotype acute leukemia (MPAL). However, the clinical significance of isolated dim MPO expression in otherwise typical B lymphoblastic leukemia (B-ALL; referred to as B/myeloid MPAL isoMPO ) in adult patients is unknown. Methods: We compared flow cytometric immunophenotype and clinicopathological findings among cases of B/myeloid MPAL isoMPO (n = 13), other MPAL subtypes (n = 10, B/myeloid and T/myeloid MPAL), B-ALL (n = 64), and acute myeloid leukemia (AML, n = 58), using the 2016 WHO classification. For MPAL cases, MPO was reported as the percent of MPO positive blasts and its intensity (dim or moderate/ strong). The pattern of heterogenous antigen expression (inversely coordinated expression between myeloid and lymphoid markers and cell size) was assessed. Results: Cases of B/myeloid MPAL isoMPO showed a fairly homogenous single Blineage blast population with dim MPO expression whereas cases of other MPAL subtypes displayed heterogeneous antigen expression and moderate/strong MPO expression. The percent of MPO positive blasts in these two groups was similar. Expressions of CD15, CD117, and monocytic markers were more common in other MPAL than in B/myeloid MPAL isoMPO . B/myeloid MPAL isoMPO patients had similar overall and leukemia free survivals as B-ALL patients and better than other MPAL patients. Conclusion: This is the first study to investigate the clinical significance of adult B/myeloid MPAL isoMPO using the 2016 WHO classification. Our results suggest that B/myeloid MPAL isoMPO clinically behaves more similarly to B-ALL than to other MPAL subtypes, supporting the 2016 WHO classification to segregate this entity from other MPAL subtypes.

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Lineage determination in mixed phenotype acute leukemia: Response to marcondes et al.

Cited by 5 publications

References 7 publications

Acute Leukemias of Ambiguous Origin

Acute Leukemias of Ambiguous Origin

Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia

Adult mixed phenotype acute leukemia (MPAL): B/myeloid MPAL^isoMPO is distinct from other MPAL subtypes

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Lineage determination in mixed phenotype acute leukemia: Response to marcondes et al.

Cited by 5 publications

References 7 publications

Acute Leukemias of Ambiguous Origin

Acute Leukemias of Ambiguous Origin

Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia

Adult mixed phenotype acute leukemia (MPAL): B/myeloid MPALisoMPO is distinct from other MPAL subtypes

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Adult mixed phenotype acute leukemia (MPAL): B/myeloid MPAL^isoMPO is distinct from other MPAL subtypes