types of ALAL

The following four different types of ALAL have been described:

1. single population mixed phenotype leukemias share immunophenotypic features of lymphoblastic and myeloid AL (ALL and AML, respectively).

   

   Most of these leukemias fulfill one of the two international definitions, both of which principally rely on flow cytometry. An older definition by the European Group for Immunophenotyping of Leukemia (EGIL) uses a spectrum of antigens weighted by their presumed significance. A newer definition by World Health Organization (WHO) utilizes fewer antigens. In general, the prognosis of ALAL is slightly worse than that of the other acute leukemias on the same type of treatment.

   EGIL definition. Score of > 2.0 for B or T lineage and for My lineage

   Scoring points	B lineage	T lineage	My lineage
   2	(intra)CD79a, intraIgM, (intra)CD22	(intra)CD3, TCRαβ, TCRγδ	intraMPO
   1	CD19, CD10, CD20	CD2, CD5, CD8, CD10	CD13,CD33,CD65,CD117
   0.5	intraTdT, CD24	intraTdT, CD7, CD1a	CD14,CD15, CD64

   WHO definition. Fulfills criteria for at least of 2 lineages

   ^†Strong defined as equal or brighter than the normal B or T cells in the sample.

   Lineage assignment	Criteria definition
   Myeloid lineage	intraMPO (flow cytometry, immunohistochemistry, or cytochemistry) or Monocytic differentiation (at least 2 of the following: nonspecific esterase cytochemistry, CD11c, CD14, CD64, lysozyme)
   T-lineage	Strong† intraCD3 or Surface CD3
   B-lineage	Strong† CD19 with at least 1 of the following strongly expressed: CD79a, intraCD22, or CD10 or Weak CD19 with at least 2 of the following strongly expressed: CD79a, intraCD22, or CD10

2. In bilineal AL, at least two separate clones of different lineages coexist.

   
   
   

3. Undifferentiated AL do not meet the criteria of ALL and AML due to a paucity of positive markers of any of the two;

   
   
   

4. AL with an early switch to a different lineage, the phenotype of leukemic cells changes during treatment, usually during its early phases, to a different lineage. If you need any info about how to treat or detect minimal resisual disease in these patients, contact Ester Mejstříková M.D, PhD. (ester.mejstrikova@lfmotol.cuni.cz).

   
   

The ALAL subtype of leukemia has a somewhat worse prognosis than that of non ALAL acute leukemia. However, the diversity of ALALs points to the fact that the prognosis of each individual patient depends largely on their laboratory findings. These findings include gene abnormalities and types of protein in the leukemia cells, underlying diseases, and, very importantly, response to the treatment given.

If you/your child with ALAL are being treated in an experienced hospital, most likely the physicians will do their best to select the best available treatment. While it is possible that the physician may contact us for a consult, it is entirely up to the physicians who are immediately in charge of the patient, whether they consult on their treatment decisions and with whom.

Chances are that your physician will ask you to participate in a study organized by our group. If you agree with such participation, your data will help you and other patients who are diagnosed with ALAL in the future. We, physicians and researchers involved in searching for the best treatment of ALAL, thank you for it!

iBFM AMBI2018 vs. iBFM AMBI2012

From results from the retrospective study, iBFM AMBI2012, we created an algorithm for treatment of ALALs. In iBFM AMBI2018 we want to test this algorithm prospectively and compare results with the previous study. We hope to see an improvement in prognosis.



iBFM AMBI2018 registry website

After we create you a user account, you can sign in here: https://ambistudy.lf2.cuni.cz. In the website you can register new patients, upload files with cytometry data and review all added data. You won′t be able to see patients′ data from other groups in the study.



registered vs. non-participant

When you register a patient to the online database, we will consider if they fulfill the criteria for joining the registry. Only patients of participating centers can be in the registry. However, non-participating patients are included even if they are diagnosed before or after the registry accrual is opened.