A Biphenotypic (Mixed Phenotypic) Acute Leukemia: Report of Two Cases with Immunophenotypic Study


Biphenotypic acute leukemia (BAL) is an uncommon clinical entity. It is a type of acute leukemia with features characteristic of both the myeloid and lymphoid lineages and for this reason is designated as mixed-lineage, hybrid or biphenotypic acute leukemia. As strict diagnostic criteria have only recently been established, the precise incidence among acute leukemia is uncertain, although it is likely to account for approximately less then 5% of all acute leukemia. BAL is now collectively considered as “mixed phenotype acute leukemia” (MPAL). We hereby report two cases of a rare disease, BAL from our institution in the light of morphology, cytochemistry, flow cytometry and review of literature regarding these cases are described.

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A. Sarma, J. Sharma, C. Bhuyan, M. Hazarika and A. Kataki, "A Biphenotypic (Mixed Phenotypic) Acute Leukemia: Report of Two Cases with Immunophenotypic Study," Open Journal of Blood Diseases, Vol. 3 No. 2, 2013, pp. 65-68. doi: 10.4236/ojbd.2013.32014.

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The authors declare no conflicts of interest.


[1] M. Borowitz, M. C. Bene, N. L. Harris, A. Porwit and E. Matutes, “Acute Leukemias of Ambiguous Lineage,” In: S. H. Swerdlow, E. Campo, N. L. Harris, et al., Eds., World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues, IARC Press, Lyon, 2008, pp. 150-155.
[2] European Group for the Immunological Classification of Leukaemias, “The Value of c-kit in the Diagnosis of Biphenotypic Acute Leukemia,” Leukemia, Vol. 12, No. 12, 1998, p. 2038. doi:10.1038/sj.leu.2401214
[3] S. Killick, E. Matutes, R. Powles, et al., “Outcome of Biphenotypic Acute Leukemia,” Haematologica, Vol. 84, No. 8, 1999, pp. 699-706.
[4] A. S. Al-Seraihy, M. Tarek, et al., “Clinical Characteristics and Outcome of Children with Biphenotypic Acute Leukemia,” Haematologica, Vol. 94, No. 12, 2009, pp. 1682-1690.
[5] C. A. Hanson, M. Abaza, S. Sheldon, et al., “Acute Biphenotypic Leukemia: Immunophenotypic and Cytogenetic an Analysis,” British Journal of Haematology, Vol. 84, No. 1, 1993, pp. 49-60. doi:10.1111/j.1365-2141.1993.tb03024.x
[6] X. Troussard and N. Maarouf, “Leucemies Biphenotypiques: Mythe, Realite, Perspectives,” Spectra Biologie, Vol. 152, 2006, pp. 34-38.
[7] M. C. Bene, “Biphenotypic, Bilineal, Ambigous or Mixed Lineage: Strange Leukemia,” Haematologica, Vol. 94, No. 7, 2009, pp. 891-893. doi:10.3324/haematol.2009.007799
[8] C. C. Zheng, J. S. Wu, X. Liu, et al., “What Is the Optimal Treatment for Biphenotypic Acute Leukemia?” Haematologica, Vol. 94, No. 12, 2009, pp. 1778-1780. doi:10.3324/haematol.2009.014829
[9] O. Legrand, J. Y. Perrot, G. Simonin, et al., “Adult Biphenotypic Acute Leukaemia: An Entity with Poor Prognosis Which Is Related to Unfavourable Cytogenetics and p-Glycoprotein Over-Expression,” British Journal of Haematology, Vol. 100, No. 1, 1998, pp. 147-155. doi:10.1046/j.1365-2141.1998.00523.x
[10] E. Matutes, W. F. Pickl, et al., “Mixed-Phenotype Acute Leukemia: Clinical and Laboratory Features and Outcome in 100 Patients Defined According to the WHO 2008 Classification,” Blood, Vol. 117, No. 11, 2011, pp. 3163-3171. doi:10.1182/blood-2010-10-314682
[11] E. Mejstrikova, et al., “Prognosis of Children with Mixed Phenotype Acute Leukemia Treated on the Basis of Consistent Immunophenotypic Criteria,” Haematologica, Vol. 95, No. 6, 2010, pp. 928-935. doi:10.3324/haematol.2009.014506

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