{"entity":{"id":"mixed-phenotype-acute-leukaemia","kind":"cancer","name":"Mixed-phenotype acute leukaemia","aka":["MPAL","Mixed phenotype acute leukemia","Acute biphenotypic leukaemia","Acute biphenotypic leukemia","Bilineal acute leukaemia","Acute leukaemia of ambiguous lineage","Mixed-phenotype acute leukaemia"],"tldr":"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).\n\nHow 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.\n\nHow common: usually quoted as 2 to 5 percent of acute leukaemias, but no registry figure is in the sources read.\n\nTreatment: 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).","asOf":"2026-09-24","wikipedia":"https://en.wikipedia.org/wiki/Mixed-phenotype_acute_leukemia","links":[{"label":"NCI PDQ: acute lymphoblastic leukaemia treatment","url":"https://www.cancer.gov/types/leukemia/patient/adult-all-treatment-pdq"},{"label":"Khoury 2022, Leukemia: the 5th edition WHO classification of haematolymphoid tumours, myeloid and histiocytic neoplasms","url":"https://doi.org/10.1038/s41375-022-01613-1"},{"label":"Maruffi 2018, Leukemia: therapy for mixed-phenotype acute leukaemia, systematic review and meta-analysis","url":"https://doi.org/10.1038/s41375-018-0058-4"},{"label":"Orgel 2020, Cancer: mixed-phenotype acute leukaemia, Children's Oncology Group cohort and research strategy","url":"https://doi.org/10.1002/cncr.32552"}],"tags":["subtype-page","wave4","haematologic","rare"],"related":["leukaemia","all-leukemia","aml","aml-npm1-kmt2a","burkitt-leukaemia"],"cancers":[],"sections":[],"technologies":["mrd-testing"],"targets":[],"drugs":["imatinib","dasatinib","cytarabine","blinatumomab"],"companies":[],"institutions":[],"pathways":[],"terms":["allogeneic-transplant"],"trials":["nct05433532"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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)"],"standardOfCare":[{"setting":"Induction","approach":"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.","refs":["all-leukemia","aml","imatinib","dasatinib","allogeneic-transplant","mrd-testing"]}],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"leukaemia"},"route":"/cancers/mixed-phenotype-acute-leukaemia/","neighbours":{"cancer":[{"id":"all-leukemia","kind":"cancer","name":"Acute lymphoblastic leukaemia","route":"/cancers/all-leukemia/"},{"id":"aml","kind":"cancer","name":"Acute myeloid leukaemia","route":"/cancers/aml/"},{"id":"burkitt-leukaemia","kind":"cancer","name":"Burkitt leukaemia","route":"/cancers/burkitt-leukaemia/"},{"id":"leukaemia","kind":"cancer","name":"Leukaemia (all types)","route":"/cancers/leukaemia/"},{"id":"myeloid-leukaemia-of-down-syndrome","kind":"cancer","name":"Myeloid leukaemia of Down syndrome","route":"/cancers/myeloid-leukaemia-of-down-syndrome/"},{"id":"aml-npm1-kmt2a","kind":"cancer","name":"NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia","route":"/cancers/aml-npm1-kmt2a/"}],"technology":[{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"}],"drug":[{"id":"blinatumomab","kind":"drug","name":"Blinatumomab","route":"/drugs/blinatumomab/"},{"id":"cytarabine","kind":"drug","name":"Cytarabine","route":"/drugs/cytarabine/"},{"id":"dasatinib","kind":"drug","name":"Dasatinib","route":"/drugs/dasatinib/"},{"id":"imatinib","kind":"drug","name":"Imatinib","route":"/drugs/imatinib/"}],"term":[{"id":"allogeneic-transplant","kind":"term","name":"Allogeneic stem cell transplant (allo-SCT)","route":"/terms/allogeneic-transplant/"}],"trial":[{"id":"nct05433532","kind":"trial","name":"Study of Azacitidine，Venetoclax，and Flumatinib in Newly Diagnosed Ph-positive Acute Leukemia and CML-AP/BP Patients","route":"/trials/nct05433532/"}]}}