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Acute leukemia of ambiguous lineage

MedGen UID:
226983
•Concept ID:
C1301357
•
Neoplastic Process
Synonyms: acute leukaemia of indeterminate lineage; acute leukaemia of undetermined lineage; Acute Leukemia of Ambiguous Lineage; acute leukemia of ambiguous lineage; Acute Leukemia of Indeterminate Lineage; Acute leukemia of indeterminate lineage; acute leukemia of indeterminate lineage; acute leukemia of undetermined lineage; ALL with myeloid markers; AML with lymphoid markers; BAL; biphenotypic acute leukaemia; biphenotypic acute leukemia; hybrid acute leukaemia; hybrid acute leukemia; Hybrid acute leukemia; mixed lineage acute leukaemia; Mixed lineage acute leukemia; mixed lineage acute leukemia; mixed phenotype acute leukaemia; mixed phenotype acute leukemia
SNOMED CT: Acute leukemia of ambiguous lineage (397345009); Acute leukemia of ambiguous lineage (721308005)
 
Monarch Initiative: MONDO:0019460
Orphanet: ORPHA86851

Definition

An acute leukemia in which the blasts lack sufficient evidence to classify as myeloid or lymphoid or they have morphologic and/or immunophenotypic characteristics of both myeloid and lymphoid cells. (WHO, 2001) [from NCI]

Professional guidelines

PubMed

Genetic Testing in the Diagnosis and Biology of Acute Leukemia.
Harris MH, Czuchlewski DR, Arber DA, Czader M
Am J Clin Pathol 2019 Aug 1;152(3):322-346. doi: 10.1093/ajcp/aqz093. PMID: 31367767

Recent clinical studies

Etiology

Incidence of myeloid neoplasms in Spain (2002-2013): a population-based study of the Spanish network of cancer registries.
Solans M, Sanvisens A, Ameijide A, Merino S, Rojas D, Alemán A, Banqueri E, Chico M, Marcos AI, de Castro V, Gil L, de Munain AL, Puigdemont M, Sánchez MJ, Perucha J, Ruiz-Armengol P, Chirlaque MD, Guevara M, Carulla M, Marcos-Gragera R
Sci Rep 2022 Jan 10;12(1):323. doi: 10.1038/s41598-021-03734-6. PMID: 35013373Free PMC Article
Favorable outcomes of acute leukemias of ambiguous lineage treated with hyperCVAD: a multi-center retrospective study.
Duong VH, Begna KH, Kashanian S, Sweet K, Wang ES, Caddell R, Shafer DA, Singh ZN, Baer MR, Al-Kali A
Ann Hematol 2020 Sep;99(9):2119-2124. Epub 2020 Jul 17 doi: 10.1007/s00277-020-04179-z. PMID: 32676733
Acute Leukemia of Ambiguous Lineage in Elderly Patients - Analysis of Survival Using Surveillance Epidemiology and End Results-Medicare Database.
Guru Murthy GS, Dhakal I, Lee JY, Mehta P
Clin Lymphoma Myeloma Leuk 2017 Feb;17(2):100-107. Epub 2016 Nov 23 doi: 10.1016/j.clml.2016.11.007. PMID: 27998706
Allo-HSCT for acute leukemia of ambiguous lineage in adults: the comparison between standard conditioning and intensified conditioning regimens.
Liu QF, Fan ZP, Wu MQ, Sun J, Wu XL, Xu D, Jiang QL, Zhang Y, Huang F, Wei YQ, Zhao J, Yu GP, Meng FY
Ann Hematol 2013 May;92(5):679-87. Epub 2012 Dec 30 doi: 10.1007/s00277-012-1662-4. PMID: 23274355
Classification of acute leukemias.
Brunning RD
Semin Diagn Pathol 2003 Aug;20(3):142-53. doi: 10.1016/s0740-2570(03)00031-5. PMID: 14552428

Diagnosis

Genomic Landscape of Mixed-Phenotype Acute Leukemia.
Hennawi M, Pakasticali N, Tashkandi H, Hussaini M
Int J Mol Sci 2022 Sep 24;23(19) doi: 10.3390/ijms231911259. PMID: 36232559Free PMC Article
How I Diagnose Acute Leukemia of Ambiguous Lineage.
Weinberg OK, Arber DA
Am J Clin Pathol 2022 Jul 1;158(1):27-34. doi: 10.1093/ajcp/aqac070. PMID: 35775438
Genetic Testing in the Diagnosis and Biology of Acute Leukemia.
Harris MH, Czuchlewski DR, Arber DA, Czader M
Am J Clin Pathol 2019 Aug 1;152(3):322-346. doi: 10.1093/ajcp/aqz093. PMID: 31367767
An update on classification, genetics, and clinical approach to mixed phenotype acute leukemia (MPAL).
Khan M, Siddiqi R, Naqvi K
Ann Hematol 2018 Jun;97(6):945-953. Epub 2018 Mar 15 doi: 10.1007/s00277-018-3297-6. PMID: 29546454
Classification of acute leukemias.
Brunning RD
Semin Diagn Pathol 2003 Aug;20(3):142-53. doi: 10.1016/s0740-2570(03)00031-5. PMID: 14552428

Therapy

Favorable outcomes of acute leukemias of ambiguous lineage treated with hyperCVAD: a multi-center retrospective study.
Duong VH, Begna KH, Kashanian S, Sweet K, Wang ES, Caddell R, Shafer DA, Singh ZN, Baer MR, Al-Kali A
Ann Hematol 2020 Sep;99(9):2119-2124. Epub 2020 Jul 17 doi: 10.1007/s00277-020-04179-z. PMID: 32676733
Mixed-phenotype acute leukemia: A cohort and consensus research strategy from the Children's Oncology Group Acute Leukemia of Ambiguous Lineage Task Force.
Orgel E, Alexander TB, Wood BL, Kahwash SB, Devidas M, Dai Y, Alonzo TA, Mullighan CG, Inaba H, Hunger SP, Raetz EA, Gamis AS, Rabin KR, Carroll AJ 3rd, Heerema NA, Berman JN, Woods WG, Loh ML, Zweidler-McKay PA, Horan JT; Children's Oncology Group Acute Leukemia of Ambiguous Lineage Task Force
Cancer 2020 Feb 1;126(3):593-601. Epub 2019 Oct 29 doi: 10.1002/cncr.32552. PMID: 31661160Free PMC Article
An update on classification, genetics, and clinical approach to mixed phenotype acute leukemia (MPAL).
Khan M, Siddiqi R, Naqvi K
Ann Hematol 2018 Jun;97(6):945-953. Epub 2018 Mar 15 doi: 10.1007/s00277-018-3297-6. PMID: 29546454
Secondary Philadelphia chromosome acquired during therapy of acute leukemia and myelodysplastic syndrome.
Kurt H, Zheng L, Kantarjian HM, Tang G, Ravandi-Kashani F, Garcia-Manero G, Gong Z, Amin HM, Konoplev SN, Routbort MJ, Han X, Wang W, Medeiros LJ, Hu S
Mod Pathol 2018 Jul;31(7):1141-1154. Epub 2018 Feb 14 doi: 10.1038/s41379-018-0014-x. PMID: 29449681
Allo-HSCT for acute leukemia of ambiguous lineage in adults: the comparison between standard conditioning and intensified conditioning regimens.
Liu QF, Fan ZP, Wu MQ, Sun J, Wu XL, Xu D, Jiang QL, Zhang Y, Huang F, Wei YQ, Zhao J, Yu GP, Meng FY
Ann Hematol 2013 May;92(5):679-87. Epub 2012 Dec 30 doi: 10.1007/s00277-012-1662-4. PMID: 23274355

Prognosis

Genomic Landscape of Mixed-Phenotype Acute Leukemia.
Hennawi M, Pakasticali N, Tashkandi H, Hussaini M
Int J Mol Sci 2022 Sep 24;23(19) doi: 10.3390/ijms231911259. PMID: 36232559Free PMC Article
Favorable outcomes of acute leukemias of ambiguous lineage treated with hyperCVAD: a multi-center retrospective study.
Duong VH, Begna KH, Kashanian S, Sweet K, Wang ES, Caddell R, Shafer DA, Singh ZN, Baer MR, Al-Kali A
Ann Hematol 2020 Sep;99(9):2119-2124. Epub 2020 Jul 17 doi: 10.1007/s00277-020-04179-z. PMID: 32676733
Genetic Testing in the Diagnosis and Biology of Acute Leukemia.
Harris MH, Czuchlewski DR, Arber DA, Czader M
Am J Clin Pathol 2019 Aug 1;152(3):322-346. doi: 10.1093/ajcp/aqz093. PMID: 31367767
An update on classification, genetics, and clinical approach to mixed phenotype acute leukemia (MPAL).
Khan M, Siddiqi R, Naqvi K
Ann Hematol 2018 Jun;97(6):945-953. Epub 2018 Mar 15 doi: 10.1007/s00277-018-3297-6. PMID: 29546454
Classification of acute leukemias.
Brunning RD
Semin Diagn Pathol 2003 Aug;20(3):142-53. doi: 10.1016/s0740-2570(03)00031-5. PMID: 14552428

Clinical prediction guides

Clinico-hematological and immunophenotypic profile of acute leukemia of ambiguous lineage: A four year experience from a single tertiary care centre of West India.
Rai V, Brahmbhatt B, Saha A, Thayakaran IP
Indian J Pathol Microbiol 2024 Jan-Mar;67(1):121-127. doi: 10.4103/ijpm.ijpm_59_22. PMID: 38358200
Secondary Philadelphia chromosome acquired during therapy of acute leukemia and myelodysplastic syndrome.
Kurt H, Zheng L, Kantarjian HM, Tang G, Ravandi-Kashani F, Garcia-Manero G, Gong Z, Amin HM, Konoplev SN, Routbort MJ, Han X, Wang W, Medeiros LJ, Hu S
Mod Pathol 2018 Jul;31(7):1141-1154. Epub 2018 Feb 14 doi: 10.1038/s41379-018-0014-x. PMID: 29449681
Clonal conversion of B lymphoid leukemia reveals cross-lineage transfer of malignant states.
Somasundaram R, Åhsberg J, Okuyama K, Ungerbäck J, Lilljebjörn H, Fioretos T, Strid T, Sigvardsson M
Genes Dev 2016 Nov 15;30(22):2486-2499. Epub 2016 Dec 2 doi: 10.1101/gad.285536.116. PMID: 27913602Free PMC Article

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