A Study of Mixed Phenotype Acute Leukemia Based on the 2008 World Health Organization Classification
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Background : We evaluated the clinical significance of revised 2008 WHO classification needed to diagnose mixed phenotype acute leukemia (MPAL). Methods : A total of 22 MPAL patients, previously diagnosed by applying the scoring system of the European Group for Immunological Classification of Acute Leukemias (EGIL) were reclassified based on the 2008 WHO classification. Results : In 2008 WHO classification, the number of monoclonal antibodies (mAbs) required for assigning more than one lineage was markedly decreased, from 26 to 11, compared with that of EGIL. Seventeen of the 22 MPAL patients were reclassified as MPAL with following details: 6 MPAL with t(9;22)(q34;q11.2); BCR-ABL1, 1 MPAL with t(v;11q23); MLL rearranged, 7 MPAL, B/Myeloid, not otherwise specified (NOS) and 3 MPAL, T/Myeloid, NOS. Five patients were excluded from MPAL in the revised classification: 4 cytoplasmic myeloperoxidase (cMPO)-negative and 1 CD19-negative. The failure of complete remission achievement and occurrence of relapse were associated with poor prognosis (P=0.0002 and P=0.009, respectively). But the presence of Philadelphia chromsome was not significantly related with patient outcome (P=0.082). One patient with cCD79a,CD20, CD38, cMPO and CD15, whose diagnosis was reclassified from MPAL to AML has survived during the study period. Conclusions : Because of decreased number of mAbs needed, it is possible that acute leukemia panel is designed to include all mAbs required to diagnose MPAL according to 2008 WHO classification. When diagnosing MPAL, it is critical to figure out positivity in either cMPO or CD19, and AML expressing more than 2 lymphoid antigens are considered as MPAL. (Korean J Lab Med 2010;30:525-32)
Abstract
Background : We evaluated the clinical significance of revised 2008 WHO classification needed to diagnose mixed phenotype acute leukemia (MPAL). Methods : A total of 22 MPAL patients, previously diagnosed by applying the scoring system of the European Group for Immunological Classification of Acute Leukemias (EGIL) were reclassified based on the 2008 WHO classification. Results : In 2008 WHO classification, the number of monoclonal antibodies (mAbs) required for assigning more than one lineage was markedly decreased, from 26 to 11, compared with that of EGIL. Seventeen of the 22 MPAL patients were reclassified as MPAL with following details: 6 MPAL with t(9;22)(q34;q11.2); BCR-ABL1, 1 MPAL with t(v;11q23); MLL rearranged, 7 MPAL, B/Myeloid, not otherwise specified (NOS) and 3 MPAL, T/Myeloid, NOS. Five patients were excluded from MPAL in the revised classification: 4 cytoplasmic myeloperoxidase (cMPO)-negative and 1 CD19-negative. The failure of complete remission achievement and occurrence of relapse were associated with poor prognosis (P=0.0002 and P=0.009, respectively). But the presence of Philadelphia chromsome was not significantly related with patient outcome (P=0.082). One patient with cCD79a,CD20, CD38, cMPO and CD15, whose diagnosis was reclassified from MPAL to AML has survived during the study period. Conclusions : Because of decreased number of mAbs needed, it is possible that acute leukemia panel is designed to include all mAbs required to diagnose MPAL according to 2008 WHO classification. When diagnosing MPAL, it is critical to figure out positivity in either cMPO or CD19, and AML expressing more than 2 lymphoid antigens are considered as MPAL. (Korean J Lab Med 2010;30:525-32)
참고문헌 (22)
- Greaves MF, "Lineage promiscuity in hemopoietic differentiation and leukemia", Blood, 67, pp.1~11 (1986)
- Smith LJ, "Lineage infidelity in acute leukemia", Blood, 61, pp.1138~1145 (1983)
- Bene MC, "Proposals for the immunological classification of acute leukemias European Group for the Immunological Characterization of Leukemias (EGIL)", Leukemia, 9, pp.1783~1786 (1995)
- "The value of c-kit in the diagnosis of biphenotypic acute leukemia. EGIL (European Group for the Immunological Classification of Leukaemias)", Leukemia, 12, pp.2038~ (1998)
- Matutes E, "Definition of acute biphenotypic leukemia", Haematologica, 82통권 : 64, pp.66~ (1997)
- Brunning RD, "Acute leukaemias of ambiguous lineage in WHO classification tumours of haematopoietic and lymphoid tissues", pp.106~107 (2001), IARC
- Borowitz MJ, "Acute leukaemias of ambiguous lineage in WHO classification tumours of haematopoietic and lymphoid tissues", pp.150~151 (2008), IARC
- Morice WG, "Predictive value of blood and bone marrow flow cytometry in B-cell lymphoma classification: comparative analysis of flow cytometry and tissue biopsy in 252 patients", Mayo Clin Proc, 83, pp.776~785 (2008)
- Cheson BD, "Revised recommendations of the International Working Group for diagnosis, standardization of response criteria, treatment outcomes and reporting standards for therapeutic trials in acute myeloid leukemia", J Clin Oncol, 21, pp.4642~4649 (2003)
- Carbonell F, "Cytogenetic findings in acute biphenotypic leukaemia", Leukemia, 10, pp.1283~1287 (1996)
- Killick S, "Outcome of biphenotypic acute leukemia", Haematologica, 84, pp.699~706 (1999)
- Legrand O, "Adult biphenotypic acute leukaemia: an entity with poor prognosis which is related to unfavourable cytogenetics and P-glycoprotein over-expression", Br J Haematol, 100, pp.147~155 (1998)
- Owaidah TM, "Cytogenetics, molecular and ultrastructural characteristics of biphenotypic acute leukemia identified by the EGIL scoring system", Leukemia, 20, pp.620~626 (2006)
- Sulak LE, "Biphenotypic acute leukemia in adults", Am J Clin Pathol, 94, pp.54~58 (1990)
- Cross AH, "Acute myeloid leukemia with T-lymphoid features: a distinct biologic and clinical entity", Blood, 72, pp.579~587 (1988)
- Shurtleff SA, "TEL", AML1 fusion resulting from a cryptic t(12;21) is the most common genetic lesion in pediatric ALL and defines a subgro up of patients with an excellent prognosis, 1995, pp.9, 1985~1989
- Liang DC, "High incidence of TEL", AML1 fusion resulting from a cryptic t(12;21) in childhood B-lineage acute lymphoblastic leukemia in Taiwan, 1996, pp.10, 991~993
- Mirro J, "Clinical and laboratory characteristics of acute leukemia with the 4;11 translocation", Blood, 67, pp.689~697 (1986)
- Lampert F, "Acute leukemia with chromosome translocation (4;11): 7 new patients and analysis of 71 cases", Blut, 54, pp.325~335 (1987)
- Lee KH, "Clinical effect of imatinib added to intensive combination chemotherapy for newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia", Leukemia, 19, pp.1509~1516 (2005)
- Lanza F, "Comparative analysis of different permeabilization methods for the flow cytometry measurement of cytoplasmic myeloperoxidase and lysozyme in normal and leukemic cells", Cytomet, 30, pp.134~144 (1997)
- Trainor KJ, "Gene rearrangement in B- and T-lymphoproliferative disease detected by the polymerase chain reaction", Blood, 78, pp.192~196 (1991)