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Martin Cernan, Tomas Szotkowski, Zuzana Pikalova
Mixed-phenotype acute leukemia (MPAL) is a heterogeneous group of hematopoietic malignancies in which blasts show markers of multiple developmental lineages and cannot be clearly classified as acute myeloid or lymphoblastic leukemias. Historically, various names and classifications were used for this rare entity accounting for 2-5% of all acute leukemias depending on the diagnostic criterias used. The currently valid classification of myeloid neoplasms and acute leukemia published by the World Health Organization (WHO) in 2016 refers to this group of diseases as MPAL...
April 18, 2017: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
Sudha Sharma, Priya Singh, Kamal Kant Sahu, Arvind Rajwanshi, Pankaj Malhotra, Shano Naseem
Histoplasmosis has been observed in patients with immunosuppression in the form of isolated pulmonary involvement and disseminated disease. However, very few cases of this type that involved pleural effusion have been reported, and none have been reported in a case individual with mixed-phenotype acute leukemia (MPAL). Herein, we report a case involving a 23 year old Punjabi man having fever and breathlessness in the postinduction therapy period for mixed-phenotype acute leukemia (MPAL) with diagnosis of histoplasmosis based on the results of pleural fluid cytologic testing...
April 1, 2017: Laboratory Medicine
Emilio J Poveda-Pagán, Carlos Lozano-Quijada, Jose V Segura-Heras, María Peral-Berna, Blanca Lumbreras
OBJECTIVES: To identify the most common referred pain (ReP) pattern of the infraspinatus myofascial trigger point (MTrP) and compare its coincidence with the original ReP pattern, to verify whether there are any significant differences by sex and types of technique and to determine the observed signs and symptoms evoked by deep dry needling (DDN) and manual palpation (MPal). DESIGN: A cohort study of patients randomized to two different examination methods (July and August 2016)...
March 7, 2017: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
Gaurav Khanna, Nishikant Avinash Damle, Shipra Agarwal, Maitrayee Roy, Deepali Jain, Soumyaranjan Mallick, Shamim Ahmed, Madhavi Tripathi, Ajay Gogia
Mixed phenotypic acute leukemia (MPAL) is a rare clinical entity. MPAL associated with myeloidsarcoma (MS) is still rarer with only three cases mentioned in English literature. MS has been described in myriads of location, most commonly in skin, gums and lymph nodes. Although theoritically possible, it is very rare to find MS involving the thyroid gland. The diagnosis of MS can be elusive, very often masquerades and mislabeled as lymphoma. A high index of clinical suspicion coupled with PET/CT findings along with morphological clues and thorough peripheral blood, and bone marrow evaluation is mandatory for arriving at the definitive diagnosis...
January 2017: Indian Journal of Nuclear Medicine: IJNM: the Official Journal of the Society of Nuclear Medicine, India
Ravikiran N Pawar, Sambhunath Banerjee, Subhajit Bramha, Shekhar Krishnan, Arpita Bhattacharya, Vaskar Saha, Anupam Chakrapani, Saurabh Bhave, Mammen Chandy, Reena Nair, Mayur Parihar, Neeraj Arora, D K Mishra
INTRODUCTION: Mixed-phenotype acute leukemias (MPALs) are a heterogeneous group of rare leukemias constituting approximately 2%-5% of all leukemias, in which assigning a single lineage of origin is not possible. They are diagnosed by either the presence of antigens of more than one lineage or by the presence of dual population of blasts belonging to two or more lineages. We highlight the clinicopathological, immunophenotype, and genetic data of a cohort (n = 14) of patients diagnosed and treated at our center...
January 2017: Indian Journal of Pathology & Microbiology
Michael N Dworzak, Barbara Buldini, Giuseppe Gaipa, Richard Ratei, Ondrej Hrusak, Drorit Luria, Eti Rosenthal, Jean-Pierre Bourquin, Mary Sartor, Angela Schumich, Leonid Karawajew, Ester Mejstrikova, Oscar Maglia, Georg Mann, Wolf-Dieter Ludwig, Andrea Biondi, Martin Schrappe, Giuseppe Basso
Immunophenotyping by flow cytometry (FCM) is a worldwide mainstay in leukemia diagnostics. For concordant multicentric application, however, a gap exists between available classification systems, technologic standardization, and clinical needs. The AIEOP-BFM consortium induced an extensive standardization and validation effort between its nine national reference laboratories collaborating in immunophenotyping of pediatric acute lymphoblastic leukemia (ALL). We elaborated common guidelines which take advantage of the possibilities of multi-color FCM: marker panel requirements, immunological blast gating, in-sample controls, tri-partite antigen expression rating (negative vs...
February 10, 2017: Cytometry. Part B, Clinical Cytometry
Ofir Wolach, Richard M Stone
PURPOSE OF REVIEW: Mixed-phenotype acute leukemia (MPAL) is a rare disease that poses many diagnostic and therapeutic challenges. Patients with MPAL are considered to have poor outcomes. The difficulties in classifying this leukemia, the lack of prospectively collected data concerning therapeutic outcomes, and rare incidence result in much uncertainty as to the best approach for patients with MPAL. RECENT FINDINGS: Recent studies demonstrated that most MPALs are associated with cytogenetic abnormalities; genetic sequencing studies disclose a high frequency of somatic mutations in genes encoding epigenetic regulators, tumor suppressors, and transcription factors...
March 2017: Current Opinion in Hematology
Alan Pomerantz, Sergio Rodriguez-Rodriguez, Roberta Demichelis-Gomez, Georgina Barrera-Lumbreras, Olga Barrales-Benitez, Xavier Lopez-Karpovitch, Alvaro Aguayo-Gonzalez
BACKGROUND: Different criteria have been used to diagnose mixed-phenotype acute leukemia (MPAL), which has impacted the number of individuals diagnosed with this pathology. Better outcomes have been reported when using acute lymphoblastic leukemia (ALL)-type chemotherapy in the treatment of MPAL. METHODS: We compared the outcome of 4 groups of patients with MPAL. Group 1 included patients diagnosed using the 2008/2016 World Health Organization (WHO) classification; group 2 included patients diagnosed using the European Group for the Immunological Characterization of Leukemias (EGIL) criteria; group 3 included patients diagnosed using either the EGIL or the 2008/2016 WHO criteria; and group 4 was comprised of patients diagnosed with MPAL using the EGIL classification only...
December 2016: Blood Research
Hee-Je Kim
No abstract text is available yet for this article.
December 2016: Blood Research
Geetha Narayanan, M T Sugeeth, Lali V Soman
Leukemia cutis (LC) is defined as infiltration of the skin by leukemic cells resulting in clinically recognizable cutaneous lesions. It is common in congenital leukemia and acute myeloid leukemia. However, LC has rarely been reported with mixed phenotypic acute leukemia (MPAL). We report the case of a lady who presented with erythematous papular and nodular lesions all over the body. Skin biopsy showed leukemic infiltration and bone marrow aspiration showed MPAL of the T/myeloid with monocytic differentiation lineage...
2016: Case Reports in Medicine
Katsuya Yamamoto, Shinichiro Kawamoto, Yu Mizutani, Kimikazu Yakushijin, Tomoe Yamashita, Yuji Nakamachi, Seiji Kawano, Yoshitake Hayashi, Hiroshi Matsuoka, Hironobu Minami
The t(12;17)(p13;q11∼21) translocation is a very rare but recurrent cytogenetic aberration observed predominantly in early pre-B acute lymphoblastic leukemia (ALL) with CD19+CD10-CD33+ phenotype. This translocation was shown to form a fusion gene between TAF15 at 17q12 and ZNF384 at 12p13. On the other hand, der(1;18)(q10;q10) has been detected as a rare unbalanced whole-arm translocation leading to trisomy 1q in myeloid malignancies. We describe here the first case of mixed phenotype acute leukemia (MPAL) with a t(12;17)(p13;q21)/TAF15-ZNF384, which also had der(1;18)(q10;q10) as an additional abnormality...
2016: Cytogenetic and Genome Research
Keisuke Otsubo, Miharu Yabe, Hiromasa Yabe, Akiko Fukumura, Tsuyoshi Morimoto, Masahiko Kato, Hiroyuki Mochizuki
Mixed-phenotype acute leukemia (MPAL) is a rare type of leukemia expressing both myeloid and lymphoid markers. There is limited information, especially on pediatric cases. Therefore, the optimal therapeutic approach to pediatric MPAL has not been defined. Here, we report two pediatric cases of MPAL. According to the 2008 World Health Organization (WHO) classification and European Group for the Immunological Characterization of Leukemias (EGIL) criteria, patient 1 was diagnosed with overt MPAL positive for the myeloid marker myeloperoxidase (MPO), and B-lymphoid markers...
October 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Hyeong Nyeon Kim, Mina Hur, Hanah Kim, Misuk Ji, Hee-Won Moon, Yeo-Min Yun, Mark Hong Lee
Mixed phenotype acute leukemia (MPAL) includes biphenotypic leukemia, bilineal leukemia, or its combination by the 2008 WHO classification. A few cases of combined biphenotypic/bilineal MPAL have been reported so far; they all had biphenotypic expressions in only one of the two distinct leukemic populations. A 43-year-old female presented with leukocytosis and bicytopenia. Her complete blood counts were: hemoglobin, 6.9 g/dL; white blood cells, 62.8×10(9)/L; and platelets, 83×10(9)/L. Neither lymphadenopathy nor organomegaly was observed...
July 2016: Annals of Clinical and Laboratory Science
Olive S Eckstein, Linghua Wang, Jyotinder N Punia, Steven M Kornblau, Michael Andreeff, David A Wheeler, Margaret A Goodell, Rachel E Rau
Mixed-phenotype acute leukemia (MPAL) is a heterogeneous group of poor-prognosis leukemias with immunophenotypic features of at least two cell lineages. The full spectrum of genetic mutations in this rare disease has not been elucidated, limiting our understanding of disease pathogenesis and our ability to devise targeted therapeutic strategies. Here, we sought to define the mutational landscape of MPAL by performing whole-exome sequencing on samples from 23 adult and pediatric MPAL patients. We identified frequent mutations of epigenetic modifiers, most notably mutations of DNMT3A, in 33% of adult MPAL patients...
August 2016: Experimental Hematology
Hiroyuki Takata, Taichi Ikebe, Hitohiro Sasaki, Yasuhiko Miyazaki, Eiichi Ohtsuka, Yoshio Saburi, Masao Ogata, Kuniaki Shirao
Philadelphia chromosome positive (Ph+) mixed phenotype acute leukemia (MPAL) is a rare type of acute leukemia having both myeloid and lymphoid features for which no optimal treatment has yet been established. We herein describe two elderly Ph+MPAL patients who achieved molecular remission without any serious adverse events by treatment with dasatinib and prednisolone. Although dasatinib induction therapy combined with prednisolone is known to be a highly effective treatment for Ph+ acute lymphoblastic leukemia, its efficacy for Ph+MPAL has not been shown...
2016: Internal Medicine
Jun Amaki, Hiromichi Matsushita, Yuka Kitamura, Ryoko Nagao, Hiromichi Murayama, Minoru Kojima, Kiyoshi Ando
We experienced the case of a 56-year-old male with B-lymphoid/myeloid lineage mixed phenotype acute leukemia (MPAL). A cytogenetic analysis of the patient's bone marrow revealed a complex karyotype, including der(9)t(7;9)(q11.2;p13). We identified an aberrant PAX5 transcript, including the exons 1A to 5 and the contiguous intron 5/6 sequence using the 3' rapid amplification of cDNA ends-polymerase chain reaction method, and confirmed their expression in the leukemic cells. Our case suggests that der(9)t(7;9)(q11...
2016: Leukemia Research Reports
Hong Tian, Yang Xu, Liming Liu, Lingzhi Yan, Zhengming Jin, Xiaowen Tang, Yue Han, Zhengzheng Fu, Huiying Qiu, Aining Sun, Depei Wu
The optimal treatment approach for mixed phenotype acute leukemia (MPAL) remains unknown, and prognostic factors for treatment outcomes need to be identified. In this study, 66 patients diagnosed with MPAL according to criteria published by the WHO in 2008 were retrospectively assessed to evaluate the effectiveness of treatment and identify predictive variables. Five patients died of severe infection after the first induction chemotherapy, 29 received alloHSCT after induction (HSCT group), and 32 received only chemotherapy (chemotherapy group)...
June 2016: Leukemia Research
Evans Roberts, Melody Oncale, Hana Safah, John Schmieg
Mixed-phenotype acute leukemia is a rare form of leukemia that is associated with a poor prognosis. Most cases of mixed-phenotype acute leukemia are de novo. However, therapy-related mixed-phenotype acute leukemia can occur, and are often associated with exposure to topoisomerase-II inhibitors and alkylating agents. There are no known treatment guidelines for therapy-related mixed-phenotype acute leukemia. We present a patient with T/myeloid mixed-phenotype acute leukemia secondary to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP chemotherapy for primary cutaneous diffuse large B-cell lymphoma...
January 2016: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
Reinhold Munker, Ruta Brazauskas, Hai Lin Wang, Marcos de Lima, Hanna J Khoury, Robert Peter Gale, Richard T Maziarz, Brenda M Sandmaier, Daniel Weisdorf, Wael Saber
Acute biphenotypic leukemias or mixed phenotype acute leukemias (MPAL) are rare and considered high risk. The optimal treatment and the role of allogeneic hematopoietic stem cell transplantation (alloHCT) are unclear. Most prior case series include only modest numbers of patients who underwent transplantation. We analyzed the outcome of 95 carefully characterized alloHCT patients with MPAL reported to the Center for International Blood and Marrow Transplant Research between 1996 and 2012. The median age was 20 years (range, 1 to 68)...
June 2016: Biology of Blood and Marrow Transplantation
Samah A Kohla, Ahmad Al Sabbagh, Halima El Omri, Firyal A Ibrahim, Ivone B Otazu, Hessa Alhajri, Mohamed A Yassin
Mixed phenotype acute leukemia (MPAL) is considered as a rare type of leukemia with an incidence of less than 4% of all acute leukemia based on the most recent 2008 WHO classification. Common subtypes are the B/myeloid and T/myeloid; B/T and trilineage MPAL being extremely rare. We present a case of a male in his 20s, whose peripheral blood smears showed 34% blast cells and bone marrow with 70% blasts. Immunophenotyping by multiparametric flow cytometry showed two populations of blasts, the major one with B-lineage and the minor one with T-lineage...
2015: Clinical Medicine Insights. Blood Disorders
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