Loading
6 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Mixed-phenotype acute leukaemia is a rare acute leukaemia whose cells carry markers of both lymphoid and myeloid lines, so it fits neither acute lymphoblastic nor acute myeloid leukaemia. Pooled evidence favours starting with the drugs used for acute lymphoblastic leukaemia, adding a targeted drug when the Philadelphia chromosome is present, and a stem cell transplant in first remission.
WHO-HAEM5 keeps mixed-phenotype acute leukaemia under acute leukaemias of ambiguous lineage, defined by blasts co-expressing lineage-defining markers (B or T with myeloid) or by two blast populations, and subdivided by genetics, BCR::ABL1 and KMT2A-rearranged, then by phenotype (B/myeloid, T/myeloid, rare types) (Khoury 2022). The meta-analysis of 1,351 evaluable patients found that acute myeloid leukaemia-type induction was less likely to achieve complete remission than acute lymphoblastic leukaemia-type or hybrid induction, and analysed survival by treatment type and transplant (Maruffi 2018). In the Children's Oncology Group cohort, acute lymphoblastic leukaemia regimens achieved remission in 72 percent (28 of 39) and acute myeloid leukaemia regimens in 69 percent (9 of 13), and the task force set out a prospective trial strategy for paediatric disease (Orgel 2020).
How it differs from its parent: it sits between the two acute leukaemia pages; its diagnosis depends on strict flow cytometry criteria (myeloperoxidase or monocytic markers for myeloid lineage, cytoplasmic CD3 for T, CD19 with CD79a, CD22 or CD10 for B), and its treatment has no randomised evidence, only pooled case series.
| Setting | Approach | Guideline |
|---|---|---|
| Induction | Acute lymphoblastic leukaemia-type induction in most patients; tyrosine kinase inhibitor for BCR::ABL1 disease; allogeneic transplant in first remission for adults and high-risk children. | not mapped |