EXPLORE THE INNER RELATION AMONG THE MORPHOLOGY,IMMUNOPHENOTYPIC, MOLECULAR GENETIC FEATURES IN MIXED PHENOTYPE ACUTE LEUKEMIA
(Abstract release date: 05/19/16)
EHA Library. Peng X. 06/09/16; 135352; LB2241
Prof. Xian-Gui Peng
Contributions
Contributions
Abstract
Abstract: LB2241
Type: Eposter Presentation
Background
The mixed phenotype acute leukemia(MPAL) is rare leukemia. The biology of MPAL is unclear.
Aims
To analyze and explore the inner relation among the Morphology, immunophenotypic,cytogenetic,molecular genetic features and prognosis of MPAL．
Methods
MICM classification by morphology and cytochemistry, flow cytometric immunophenotyping,conventional cytogenetic,fluorescence in situ hybridization (FISH) and/or molecular genetic, was used to relrospectively study 2575 patients with AL from January 2008 to March 2015．
Results
The results showed that 30(1.16%) cases were diagnosed as MPAL,fulfilling WHO 2008 criteria. 13 cases of 30 MPALs’Leukemia cells presented the same kind of morphological characteristics,leukemia cells of the other 17 cases has two different morphological characteristics(The two kinds of cells were more than double in volume.Ⅰ. Maxicell：around 16 to 25 um, morphological characteristics similar to myeloid myeloblast and/or monoblast,POX positive.Ⅱ. Cellule:around 8 to 12 um,morphological characteristics similar to lymphocytes,but is not a classic myeloblast,monoblast or lymphoblast，Cytoplasm pseudopodia,burr shape change,drag the caudate,containing A particle or not, folded or irregular nuclei). Based on FAB criteria,12(40%) patients showed AML morphologies, mainly M1 and M5,the dominant subtype.6(20%) patients were classified ALL,7(23.3%) patients were classified hybrid acute leukemia(HAL).The remaining 5(16.7%) cases resisted classification by morphology and were categorized as acute undifferentiated leukemia. Immunophenotyping data showed that 16 of 30 cases(53.3%) had combined B-lymphoid+myeloid immunophenotype(B+My),12(40%) combined T-lymphoid+myeloid immunophenotype(T+My),1(3.33%)B+T- lymphoid immunophenotype (B+T),and in the remaining 1(3.33%) cases there was evidence of trilineage concomitant expression [myeloid,B,and T lymphoid(My+B+T)].In addition, there are 1/16 cases of MY+B with T-lineage marker CD7+ not as trilineage.There were high expression of stem/progenitor cell markers CD123,CD34,CD38 and HLA-DR in MPAL;with the positive rate of 100%,93.3%,90% and 92.6%,respectively. A total of 11 (36.7%) had Ph chromosome and/or BCR-ABL fusion gene by FISH and/or RT-PCR. Median WBC of peripheral blood was 149×109/L ranging between 1.46×109/L and 797×109/L.Compared with Ph-MPAL,it has statistical significance that①combined B+My immunophenotype(P＜0.001) and②the peripheral blood was found to be immature granulocytes (promyelocytic, myelocyte and metagranulocyte)by smears for morphology (P=0.002),at the positive rate of 90.9%(10 of 11 cases)in Ph+MPALs. 7 cases of HAL by morphology associated with the BCR-ABL fusion gene(P=0.01),and these appeared as combined B+My immunophenotype. 22 of 30 patients were treated with at least 2 cycles of chemical drugs,with the complete response(CR) rate of 59.1%(13/22). This study found：①In these 30 cases of MPALs, according to our set of morphological classification scheme，the ALL often appeared as combined B+My immunophenotype that was diagnosed by morphology;the combined T+My immunophenotype cases usually showed AML by morphological classification.②While myeloid and lymphoid blast cells were simutalously seen in BM, high leukocyte and high immature granulocytes were seen in PB, and with B+My immunophenotype, it often hint MPAL with Ph chromosome or BCR-ABL fusion gene.
Conclusion
MPAL is a set of heterogeneous disease that originated in the stage of pluripotent stem cell and have directional differentiation potential,mainly presents the characteristic of myeloid differentiation.
Session topic: E-poster
Keyword(s): Mixed lineage leukemia
Type: Eposter Presentation
Background
The mixed phenotype acute leukemia(MPAL) is rare leukemia. The biology of MPAL is unclear.
Aims
To analyze and explore the inner relation among the Morphology, immunophenotypic,cytogenetic,molecular genetic features and prognosis of MPAL．
Methods
MICM classification by morphology and cytochemistry, flow cytometric immunophenotyping,conventional cytogenetic,fluorescence in situ hybridization (FISH) and/or molecular genetic, was used to relrospectively study 2575 patients with AL from January 2008 to March 2015．
Results
The results showed that 30(1.16%) cases were diagnosed as MPAL,fulfilling WHO 2008 criteria. 13 cases of 30 MPALs’Leukemia cells presented the same kind of morphological characteristics,leukemia cells of the other 17 cases has two different morphological characteristics(The two kinds of cells were more than double in volume.Ⅰ. Maxicell：around 16 to 25 um, morphological characteristics similar to myeloid myeloblast and/or monoblast,POX positive.Ⅱ. Cellule:around 8 to 12 um,morphological characteristics similar to lymphocytes,but is not a classic myeloblast,monoblast or lymphoblast，Cytoplasm pseudopodia,burr shape change,drag the caudate,containing A particle or not, folded or irregular nuclei). Based on FAB criteria,12(40%) patients showed AML morphologies, mainly M1 and M5,the dominant subtype.6(20%) patients were classified ALL,7(23.3%) patients were classified hybrid acute leukemia(HAL).The remaining 5(16.7%) cases resisted classification by morphology and were categorized as acute undifferentiated leukemia. Immunophenotyping data showed that 16 of 30 cases(53.3%) had combined B-lymphoid+myeloid immunophenotype(B+My),12(40%) combined T-lymphoid+myeloid immunophenotype(T+My),1(3.33%)B+T- lymphoid immunophenotype (B+T),and in the remaining 1(3.33%) cases there was evidence of trilineage concomitant expression [myeloid,B,and T lymphoid(My+B+T)].In addition, there are 1/16 cases of MY+B with T-lineage marker CD7+ not as trilineage.There were high expression of stem/progenitor cell markers CD123,CD34,CD38 and HLA-DR in MPAL;with the positive rate of 100%,93.3%,90% and 92.6%,respectively. A total of 11 (36.7%) had Ph chromosome and/or BCR-ABL fusion gene by FISH and/or RT-PCR. Median WBC of peripheral blood was 149×109/L ranging between 1.46×109/L and 797×109/L.Compared with Ph-MPAL,it has statistical significance that①combined B+My immunophenotype(P＜0.001) and②the peripheral blood was found to be immature granulocytes (promyelocytic, myelocyte and metagranulocyte)by smears for morphology (P=0.002),at the positive rate of 90.9%(10 of 11 cases)in Ph+MPALs. 7 cases of HAL by morphology associated with the BCR-ABL fusion gene(P=0.01),and these appeared as combined B+My immunophenotype. 22 of 30 patients were treated with at least 2 cycles of chemical drugs,with the complete response(CR) rate of 59.1%(13/22). This study found：①In these 30 cases of MPALs, according to our set of morphological classification scheme，the ALL often appeared as combined B+My immunophenotype that was diagnosed by morphology;the combined T+My immunophenotype cases usually showed AML by morphological classification.②While myeloid and lymphoid blast cells were simutalously seen in BM, high leukocyte and high immature granulocytes were seen in PB, and with B+My immunophenotype, it often hint MPAL with Ph chromosome or BCR-ABL fusion gene.
Conclusion
MPAL is a set of heterogeneous disease that originated in the stage of pluripotent stem cell and have directional differentiation potential,mainly presents the characteristic of myeloid differentiation.
Session topic: E-poster
Keyword(s): Mixed lineage leukemia
Abstract: LB2241
Type: Eposter Presentation
Background
The mixed phenotype acute leukemia(MPAL) is rare leukemia. The biology of MPAL is unclear.
Aims
To analyze and explore the inner relation among the Morphology, immunophenotypic,cytogenetic,molecular genetic features and prognosis of MPAL．
Methods
MICM classification by morphology and cytochemistry, flow cytometric immunophenotyping,conventional cytogenetic,fluorescence in situ hybridization (FISH) and/or molecular genetic, was used to relrospectively study 2575 patients with AL from January 2008 to March 2015．
Results
The results showed that 30(1.16%) cases were diagnosed as MPAL,fulfilling WHO 2008 criteria. 13 cases of 30 MPALs’Leukemia cells presented the same kind of morphological characteristics,leukemia cells of the other 17 cases has two different morphological characteristics(The two kinds of cells were more than double in volume.Ⅰ. Maxicell：around 16 to 25 um, morphological characteristics similar to myeloid myeloblast and/or monoblast,POX positive.Ⅱ. Cellule:around 8 to 12 um,morphological characteristics similar to lymphocytes,but is not a classic myeloblast,monoblast or lymphoblast，Cytoplasm pseudopodia,burr shape change,drag the caudate,containing A particle or not, folded or irregular nuclei). Based on FAB criteria,12(40%) patients showed AML morphologies, mainly M1 and M5,the dominant subtype.6(20%) patients were classified ALL,7(23.3%) patients were classified hybrid acute leukemia(HAL).The remaining 5(16.7%) cases resisted classification by morphology and were categorized as acute undifferentiated leukemia. Immunophenotyping data showed that 16 of 30 cases(53.3%) had combined B-lymphoid+myeloid immunophenotype(B+My),12(40%) combined T-lymphoid+myeloid immunophenotype(T+My),1(3.33%)B+T- lymphoid immunophenotype (B+T),and in the remaining 1(3.33%) cases there was evidence of trilineage concomitant expression [myeloid,B,and T lymphoid(My+B+T)].In addition, there are 1/16 cases of MY+B with T-lineage marker CD7+ not as trilineage.There were high expression of stem/progenitor cell markers CD123,CD34,CD38 and HLA-DR in MPAL;with the positive rate of 100%,93.3%,90% and 92.6%,respectively. A total of 11 (36.7%) had Ph chromosome and/or BCR-ABL fusion gene by FISH and/or RT-PCR. Median WBC of peripheral blood was 149×109/L ranging between 1.46×109/L and 797×109/L.Compared with Ph-MPAL,it has statistical significance that①combined B+My immunophenotype(P＜0.001) and②the peripheral blood was found to be immature granulocytes (promyelocytic, myelocyte and metagranulocyte)by smears for morphology (P=0.002),at the positive rate of 90.9%(10 of 11 cases)in Ph+MPALs. 7 cases of HAL by morphology associated with the BCR-ABL fusion gene(P=0.01),and these appeared as combined B+My immunophenotype. 22 of 30 patients were treated with at least 2 cycles of chemical drugs,with the complete response(CR) rate of 59.1%(13/22). This study found：①In these 30 cases of MPALs, according to our set of morphological classification scheme，the ALL often appeared as combined B+My immunophenotype that was diagnosed by morphology;the combined T+My immunophenotype cases usually showed AML by morphological classification.②While myeloid and lymphoid blast cells were simutalously seen in BM, high leukocyte and high immature granulocytes were seen in PB, and with B+My immunophenotype, it often hint MPAL with Ph chromosome or BCR-ABL fusion gene.
Conclusion
MPAL is a set of heterogeneous disease that originated in the stage of pluripotent stem cell and have directional differentiation potential,mainly presents the characteristic of myeloid differentiation.
Session topic: E-poster
Keyword(s): Mixed lineage leukemia
Type: Eposter Presentation
Background
The mixed phenotype acute leukemia(MPAL) is rare leukemia. The biology of MPAL is unclear.
Aims
To analyze and explore the inner relation among the Morphology, immunophenotypic,cytogenetic,molecular genetic features and prognosis of MPAL．
Methods
MICM classification by morphology and cytochemistry, flow cytometric immunophenotyping,conventional cytogenetic,fluorescence in situ hybridization (FISH) and/or molecular genetic, was used to relrospectively study 2575 patients with AL from January 2008 to March 2015．
Results
The results showed that 30(1.16%) cases were diagnosed as MPAL,fulfilling WHO 2008 criteria. 13 cases of 30 MPALs’Leukemia cells presented the same kind of morphological characteristics,leukemia cells of the other 17 cases has two different morphological characteristics(The two kinds of cells were more than double in volume.Ⅰ. Maxicell：around 16 to 25 um, morphological characteristics similar to myeloid myeloblast and/or monoblast,POX positive.Ⅱ. Cellule:around 8 to 12 um,morphological characteristics similar to lymphocytes,but is not a classic myeloblast,monoblast or lymphoblast，Cytoplasm pseudopodia,burr shape change,drag the caudate,containing A particle or not, folded or irregular nuclei). Based on FAB criteria,12(40%) patients showed AML morphologies, mainly M1 and M5,the dominant subtype.6(20%) patients were classified ALL,7(23.3%) patients were classified hybrid acute leukemia(HAL).The remaining 5(16.7%) cases resisted classification by morphology and were categorized as acute undifferentiated leukemia. Immunophenotyping data showed that 16 of 30 cases(53.3%) had combined B-lymphoid+myeloid immunophenotype(B+My),12(40%) combined T-lymphoid+myeloid immunophenotype(T+My),1(3.33%)B+T- lymphoid immunophenotype (B+T),and in the remaining 1(3.33%) cases there was evidence of trilineage concomitant expression [myeloid,B,and T lymphoid(My+B+T)].In addition, there are 1/16 cases of MY+B with T-lineage marker CD7+ not as trilineage.There were high expression of stem/progenitor cell markers CD123,CD34,CD38 and HLA-DR in MPAL;with the positive rate of 100%,93.3%,90% and 92.6%,respectively. A total of 11 (36.7%) had Ph chromosome and/or BCR-ABL fusion gene by FISH and/or RT-PCR. Median WBC of peripheral blood was 149×109/L ranging between 1.46×109/L and 797×109/L.Compared with Ph-MPAL,it has statistical significance that①combined B+My immunophenotype(P＜0.001) and②the peripheral blood was found to be immature granulocytes (promyelocytic, myelocyte and metagranulocyte)by smears for morphology (P=0.002),at the positive rate of 90.9%(10 of 11 cases)in Ph+MPALs. 7 cases of HAL by morphology associated with the BCR-ABL fusion gene(P=0.01),and these appeared as combined B+My immunophenotype. 22 of 30 patients were treated with at least 2 cycles of chemical drugs,with the complete response(CR) rate of 59.1%(13/22). This study found：①In these 30 cases of MPALs, according to our set of morphological classification scheme，the ALL often appeared as combined B+My immunophenotype that was diagnosed by morphology;the combined T+My immunophenotype cases usually showed AML by morphological classification.②While myeloid and lymphoid blast cells were simutalously seen in BM, high leukocyte and high immature granulocytes were seen in PB, and with B+My immunophenotype, it often hint MPAL with Ph chromosome or BCR-ABL fusion gene.
Conclusion
MPAL is a set of heterogeneous disease that originated in the stage of pluripotent stem cell and have directional differentiation potential,mainly presents the characteristic of myeloid differentiation.
Session topic: E-poster
Keyword(s): Mixed lineage leukemia
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