Medknow Publications on behalf of Indian Cancer Society
Abstract
Background : We present a clinico-hematological profile and treatment
outcome of Biphenotypic Acute Leukemia (BAL). Aim : Study incidence
and subtypes of BAL, correlate with age, morphology, and cytogenetic
findings and correlate the clinico-hematological data with the
treatment response. St Jude\u2032s and the EGIL\u2032s criteria have
been compared for their diagnostic and clinical relevance. Material
and Methods : Diagnosis was based on WHO classification, including
clinical details, morphology, cytochemistry, immunophenotyping, and
molecular genetics. We included those cases, which fulfilled the
European Group for the Immunological Characterization of Acute
Leukemia\u2032s (EGIL\u2032s) scoring system criteria for the
diagnosis of BAL, as per recommendation of the WHO classification.
Results : There were 32 patients diagnosed with BAL, based on
EGIL\u2032s criteria. Incidence of BAL was 1.2%. B-Myeloid (14 cases)
followed by T-Myeloid BAL (13 cases) were the commonest subtypes.
Polymorphous population of blasts (16 cases) was commonly associated
with T-Myeloid BAL (10 cases). BCR ABL fusion positivity was a common
cytogenetic abnormality (seven cases). Fifteen patients received
chemotherapy; eight achieved complete remission (CR) at the end of the
induction period. Conclusions : Pediatric BAL and T-B lymphoid BAL
have a better prognosis. A comprehensive panel of reagents is required,
including cytoplasmic markers; to diagnose BAL. St Jude\u2032s
criteria is a simple, easy, and cost-effective method to diagnose BAL.
The outcome-related prognostic factors include age, HLA-DR, CD34
negativity, and subtype of BAL. BCR-ABL expression is an important
prognostic factor, as these cases will be labeled as Chronic myeloid
leukemia (CML) in blast crisis with biphenotypic expression and treated
accordingly