title: Cytogenetics, molecular and ultrastructural characteristics of biphenotypic acute leukemia identified by the EGIL scoring system.
abstract: Biphenotypic acute leukemia (BAL) is a rare, difficult to diagnose entity. Its identification is important for risk stratification in acute leukemia (AL). The scoring proposal of the European Group for the Classification of Acute Leukemia (EGIL) is useful for this purpose, but its performance against objective benchmarks is unclear. Using the EGIL system, we identified 23 (3.4%) BAL from among 676 newly diagnosed AL patients. Mixed, small and large blast cells predominated, with FAB M2 and L1 constituting the majority. All patients were positive for myeloid (M) markers and either B cell (B) (17 or 74%) or T cell (T) (8 or 34%) markers with two exceptional patients demonstrating trilineage phenotype. Six (50%) of studied M-B cases were positive for both IGH and TCR. In six (26%) patients myeloid lineage commitment was also demonstrable by electron cytochemistry. Abnormal findings were present in 19 (83%) patients by cytogenetics/FISH/molecular analysis as follows: t(9;22) (17%); MLL gene rearrangement (26%); deletion(6q) (13%); 12p11.2 (9%); numerical abnormalities (13%), and three (13%) new, previously unreported translocations t(X;6)(p22.3;q21); t(2;6)(q37;p21.3); and t(8;14)(p21;q32). In conclusion, the EGIL criteria for BAL appear robust when compared against molecular techniques that, if applied routinely, could aid in detecting BAL and help in risk stratification.
authors.affiliation: Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. towaidah@kfshrc.edu.sa
authors.forename: T M
authors.initials: TM
authors.lastname: Owaidah
authors.forename: A
authors.initials: A
authors.lastname: Al Beihany
authors.forename: M A
authors.initials: MA
authors.lastname: Iqbal
authors.forename: N
authors.initials: N
authors.lastname: Elkum
authors.forename: G T
authors.initials: GT
authors.lastname: Roberts
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D019070:Cell Lineage; D002648:Child; D002675:Child, Preschool; D002869:Chromosome Aberrations; D002877:Chromosomes, Human / Q000235:genetics*; D015331:Cohort Studies; D020732:Cytogenetic Analysis / Q000379:methods*; D004252:DNA Mutational Analysis; D005260:Female; D015321:Gene Rearrangement; D017408:Guidelines as Topic; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods; D066298:In Vitro Techniques; D007223:Infant; D007938:Leukemia / Q000145:classification / Q000175:diagnosis* / Q000235:genetics*; D008297:Male; D051788:Myeloid-Lymphoid Leukemia Protein / Q000235:genetics; D010641:Phenotype; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D051788:Myeloid-Lymphoid Leukemia Protein