Mixed Phenotype Acute Leukemia with Two Immunophenotypically Distinct B and T Blasts Populations, Double Ph^sup +^ Chromosome and Complex Karyotype: Report of an Unusual Case

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...

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Veröffentlicht in:Clinical medicine insights. Blood disorders 2015-01, Vol.8, p.25
Hauptverfasser: Kohla, Samah A, Sabbagh, Ahmad Al, Omri, Halima El, Ibrahim, Firyal A, Otazu, Ivone B, Alhajri, Hessa, Yassin, Mohamed A
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container_title Clinical medicine insights. Blood disorders
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creator Kohla, Samah A
Sabbagh, Ahmad Al
Omri, Halima El
Ibrahim, Firyal A
Otazu, Ivone B
Alhajri, Hessa
Yassin, Mohamed A
description 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. Conventional karyotyping revealed complex karyotype with the presence of double Philadelphia chromosome (Ph^sup +^). BCR/ABL1 rearrangement was confirmed by fluorescent in situ hybridization (FISH) analysis. The BCR/ABL1 ES probe on interphase cells indicated p190 minor m-BCR/ABL fusion in 46% and a second abnormal clone with double Ph^sup +^ in 16% of the cells analyzed confirmed by reverse transcription-PCR (RT-PCR). The case was diagnosed as MPAL with double Philadelphia chromosome Ph^sup +^. The patient was treated with dasatinib, four cycle hyper CVAD/methotrexate cytarabin protocol, and allogeneic transplant. He is still alive in complete hematological, cytogenetic, and molecular remission. Mixed phenotype B/T acute leukemia is an extremely rare disease, particularly those with double Philadelphia chromosomes and clinically presents challenges in diagnosis and treatment.
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title Mixed Phenotype Acute Leukemia with Two Immunophenotypically Distinct B and T Blasts Populations, Double Ph^sup +^ Chromosome and Complex Karyotype: Report of an Unusual Case
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