MPAL: Difference between revisions
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'''Important Note''' | '''Important Note''' | ||
Flow cytometry is an important element that may alert clinicians to a diagnosis of MPAL and has an advantage of rapidity. However conclusions may subsequently be modified (e.g. by results of immunohistochemistry, cytogenetics, or genetics). In some cases, findings will re-assign with significant treatment implications. It is important that this is acknowledged when assigning an initial diagnosis of MPAL. | Flow cytometry is an important element that may alert clinicians to a diagnosis of MPAL and has an advantage of rapidity. However conclusions may subsequently be modified (e.g. by results of immunohistochemistry, cytogenetics, or genetics). In some cases, findings will re-assign with significant treatment implications. It is important that this is acknowledged when assigning an initial diagnosis of MPAL. | ||
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Revision as of 11:51, 16 November 2023
Important Note
Flow cytometry is an important element that may alert clinicians to a diagnosis of MPAL and has an advantage of rapidity. However conclusions may subsequently be modified (e.g. by results of immunohistochemistry, cytogenetics, or genetics). In some cases, findings will re-assign with significant treatment implications. It is important that this is acknowledged when assigning an initial diagnosis of MPAL.
Frequency of MPAL types
- MPAL with features of Myeloid and B-lineage
- MPAL with features of Myeloid and T-lineage
- MPAL with features of T- and B-lineage
- acute Undifferentiated leukaemia
Following further analysis cases may be assigned additionally as: MPAL with t(9;22) (q34.1;q11.2); BCR-ABL1) MPAL with t(v;11q23.3); with KMT2A re-arrangement
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Requirements to assign myeloid lineage in MPAL
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Marker option 1 | |
Demonstrate expression of Myeloperoxidase (MPO) | Myeloperoxidase expression alone may be sufficient to establish myeloid lineage, but be aware of the limitations: (1) intensity should be at least half of that of mature neutrophils in at least of proportion of cells measured by the same method; (2) there are circumstances where judgement is required (see notes). |
Marker option 2 | |
Demonstrate clear evidence of monocytic lineage | If MPO is not demonstrated then myeloid lineage may still be assigned through demonstration of monocytic features. This can be assigned by the detection of at least two of the following features: By flow cytometry: CD11c, CD14, CD64; by other approaches: lysozyme or non-specific esterase in malignant cells (enzyme cytochemistry) |
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NOTE Interpretation of MPO positivity in MPAL
1. The techniques used to detect MPO do not have the same sensitivity: immunohistochemistry > flow cytometry > enzyme-cytochemistry. This means diagnosis of MPAL may be method dependent – expressing MPO as intensity allows expression to be compared with that of normal cells detected using the same method.
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Requirements to assign B-lymphoid lineage in MPAL
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Marker option 1 | |
Required Strong expression of CD19 | To meet the definition of "strong" the expression intensity must exceed that of 50% of normal B lymphocytes |
In addition 1 of: CD10, CD22, or CD79a (surface or cytoplasmic) | If CD19 is strong then B-lineage can be assigned if there is at least ONE of these additional markers |
Marker option 2 | |
Required Weak expression of CD19 | To meet the definition of "weak" the expression intensity must be less than that of 50% of normal B lymphocytes |
In addition 2 of: CD10, CD22, or CD79a (surface or cytoplasmic) | If CD19 is weak then B-lineage can be assigned only if there are at least TWO of these additional markers |
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Requirements to assign T-lymphoid lineage in MPAL
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Marker requirement | |
Either CD3 surface or cytoplasm (strong) | To meet the definition of "strong" the expression intensity must exceed that of 50% of normal T lymphocytes |
Or CD3 by immunocytochemistry (strong) | For immunohistochemistry it is important a non-zeta chain reagent is used |