# Mixed-phenotype acute leukaemia

Source: https://onco.cc/cancers/mixed-phenotype-acute-leukaemia/  
OnCo record `mixed-phenotype-acute-leukaemia` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

How common: usually quoted as 2 to 5 percent of acute leukaemias, but no registry figure is in the sources read.

Treatment: acute lymphoblastic leukaemia-type induction in most patients, with a tyrosine kinase inhibitor added for BCR::ABL1 disease and menin inhibitors under study for KMT2A-rearranged disease; allogeneic transplant in first remission for adults and high-risk children; measurable residual disease guides the choice, following the acute lymphoblastic and acute myeloid leukaemia pages (Maruffi 2018; Orgel 2020).

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: MPAL; Mixed phenotype acute leukemia; Acute biphenotypic leukaemia; Acute biphenotypic leukemia; Bilineal acute leukaemia; Acute leukaemia of ambiguous lineage; Mixed-phenotype acute leukaemia
- Tags: subtype-page; wave4; haematologic; rare
- Group: haematologic
- Burden: Rare: a systematic review compiled 1,499 unique patients from 97 reports in 33 countries (Maruffi 2018); the Children's Oncology Group confirmed 54 of 70 banked cases as meeting WHO 2016 criteria (Orgel 2020). Usually quoted as 2 to 5 percent of acute leukaemias; no registry figure is in the sources read.
- Subtypes: Mixed-phenotype acute leukaemia with BCR::ABL1 (add a tyrosine kinase inhibitor); Mixed-phenotype acute leukaemia with KMT2A rearrangement (infants; menin inhibitors under study); Mixed-phenotype acute leukaemia, B/myeloid, not otherwise specified; Mixed-phenotype acute leukaemia, T/myeloid, not otherwise specified; Acute undifferentiated leukaemia (related, no lineage markers)
- Biomarkers: Flow cytometry: myeloperoxidase or monocytic markers with cytoplasmic CD3 or CD19 plus CD79a, CD22 or CD10; BCR::ABL1 and KMT2A rearrangement; Measurable residual disease after induction; Two distinct blast populations (bilineal)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/mixed-phenotype-acute-leukaemia/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/mixed-phenotype-acute-leukaemia/#overview
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/mixed-phenotype-acute-leukaemia/#what-it-is [5 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/mixed-phenotype-acute-leukaemia/#finding-it [4 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/mixed-phenotype-acute-leukaemia/#treating-it [1 setting, 1 decision with options]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/mixed-phenotype-acute-leukaemia/#evidence [1 trial]
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/mixed-phenotype-acute-leukaemia/#science [6 targets]
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/mixed-phenotype-acute-leukaemia/where-you-are/
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/mixed-phenotype-acute-leukaemia/#living-with-it [8 questions, 3 red cards]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/mixed-phenotype-acute-leukaemia/coming/ [4 medicines]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/mixed-phenotype-acute-leukaemia/data/ [20 connected records]

## Standard of care

- 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. ([Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Imatinib](https://onco.cc/drugs/imatinib/), [Dasatinib](https://onco.cc/drugs/dasatinib/), [Allogeneic stem cell transplant (allo-SCT)](https://onco.cc/terms/allogeneic-transplant/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/))

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Mixed-phenotype_acute_leukemia
- NCI PDQ: acute lymphoblastic leukaemia treatment: https://www.cancer.gov/types/leukemia/patient/adult-all-treatment-pdq
- Khoury 2022, Leukemia: the 5th edition WHO classification of haematolymphoid tumours, myeloid and histiocytic neoplasms: https://doi.org/10.1038/s41375-022-01613-1
- Maruffi 2018, Leukemia: therapy for mixed-phenotype acute leukaemia, systematic review and meta-analysis: https://doi.org/10.1038/s41375-018-0058-4
- Orgel 2020, Cancer: mixed-phenotype acute leukaemia, Children's Oncology Group cohort and research strategy: https://doi.org/10.1002/cncr.32552

## Connected records

- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Burkitt leukaemia](https://onco.cc/cancers/burkitt-leukaemia/), [Leukaemia (all types)](https://onco.cc/cancers/leukaemia/), [Myeloid leukaemia of Down syndrome](https://onco.cc/cancers/myeloid-leukaemia-of-down-syndrome/), [NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia](https://onco.cc/cancers/aml-npm1-kmt2a/)
- technologies: [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/)
- drugs: [Blinatumomab](https://onco.cc/drugs/blinatumomab/), [Cytarabine](https://onco.cc/drugs/cytarabine/), [Dasatinib](https://onco.cc/drugs/dasatinib/), [Imatinib](https://onco.cc/drugs/imatinib/)
- terms: [Allogeneic stem cell transplant (allo-SCT)](https://onco.cc/terms/allogeneic-transplant/)
- trials: [Study of Azacitidine，Venetoclax，and Flumatinib in Newly Diagnosed Ph-positive Acute Leukemia and CML-AP/BP Patients](https://onco.cc/trials/nct05433532/)

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JSON: https://onco.cc/api/v1/entities/mixed-phenotype-acute-leukaemia.json