MPAL: Difference between revisions

Revision as of 19:05, 26 July 2023

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Definition of MPAL (WHO) Section 1 - defining Myeloid lineage in MPAL The first step in AML diagnosis to establish the primitive nature of the abnormal cells: (1) Typically AML blasts have low CD45 expression and cause low side scatter. This means that they form a relatively uniform and distinctive population that is clearly separate from that of lymphocytes on CD45/SSc plots (for further details see this section). It is important to realise however also not all AML cases may fit this pattern low CD45/low SSc pattern - particularly APL and monocytic AML. (2) Additional markers often expressed on myeloid cells may help confirm the primitive nature of the cells: in AML this is most often CD34, although other markers may contribute and are also listed.
Marker combination 1
Myeloperoxidase (MPO)	This marker alone is sufficient to establish myeloid lineage provided it meets the intensity definition - intensity should be at least half of that of mature neutrophils in at least of proportion of cells.
Marker combination 2
If MPO does not meet criteria for myeloid lineage, then myeloid lineage may still be assigned through demonstration of monocytic lineage: AT LEAST TWO of the following markers are expressed: CD11c, CD14, CD64		Alternatively: lysozyme Non-specific esterase,

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 |colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Marker combination 2'''
 |-
-|colspan="2" style = "font-size:90%;|In the context of a proven AML diagnosis a number of markers may be expressed that are considered to predominantly reflect their primitive nature. Some of these are more frequently associated with lymphoid disorders, but providing other criteria for AML are met their presence does not change lineage assignment. These include [[TDT]], [[CD7]], other?
+|colspan="2" style = "font-size:90%;|If MPO does not meet criteria for myeloid lineage, then myeloid lineage may still be assigned through demonstration of monocytic lineage: '''AT LEAST TWO''' of the following markers are expressed: [[CD11c]], [[CD14]], [[CD64]]
+|Alternatively: lysozyme Non-specific esterase,
 |-
 |}