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Flow Cytometry to Estimate Leukemia Stem Cells in Primary Acute Myeloid Leukemia and in Patient-derived-xenografts, at Diagnosis and Follow Up

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Mixed Phenotype Acute Leukemia: Lineage Assignment, Immunophenotypic Classification and Genetic Insights.

Vasiliki Leventaki¹, Sa A Wang¹

¹Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Human Pathology

|June 25, 2026

Summary

This summary is machine-generated.

Mixed phenotype acute leukemia (MPAL) is a rare blood cancer with complex genetic and immunophenotypic features. Understanding these characteristics is crucial for accurate diagnosis and subclassification of MPAL.

Keywords:

ALAL BCL11B BCR::ABL1 Bilineage Biphenotypic KMT2A MPAL ZNF384

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Area of Science:

Hematology
Oncology
Genetics

Background:

Mixed phenotype acute leukemia (MPAL) is a rare and heterogeneous hematologic malignancy.
It is characterized by the presence of myeloid and lymphoid blasts or coexpression of myeloid and lymphoid markers.
MPAL presents diagnostic and therapeutic challenges due to its complexity.

Purpose of the Study:

To review the current understanding of the immunophenotypic and genetic landscape of MPAL.
To emphasize the integration of diagnostic findings for MPAL subclassification.
To highlight the importance of genomic profiling in characterizing MPAL subtypes.

Main Methods:

Review of current literature on MPAL diagnosis and classification.
Integration of morphologic, immunophenotypic, cytogenetic, and molecular findings.
Analysis of diagnostic criteria from WHO and ICC classifications.

Main Results:

MPAL classification relies on multiparameter flow cytometry, cytogenetics, and molecular studies.
Specific genetic subtypes, including BCR::ABL1 and KMT2A rearrangements, are recognized.
Recurrent genetic alterations in transcription factors, epigenetic regulators, and signaling pathways are identified.

Conclusions:

Distinct genetic lesions correlate with specific immunophenotypic patterns in MPAL.
These correlations offer insights into lineage plasticity and leukemogenesis.
Accurate diagnosis and subclassification of MPAL require integrated analysis of diverse findings.