Weak CD19 with at least 2 of the following strongly expressed: CD79a, cCD22,CD10 Strong CD19 with at least one of the following strongly expressed: CD79a, cCD22,CD10 Surface CD3 (rare in mixed phenotypic acute leukemia) Monocytic differentiation (at least 2 of the following:NSE,CD11c,CD14,CD64,lysozyme)Ĭytoplasmic CD3( flow cytometry with antibodies to CD3 epsilon chain immunohistochemistry using polyclonal anti- CD3 antibody may detect CD3 zeta chain, which is not T-cell specific) Myeloperoxidase (flow cytometry, immunochemistry or cytochemistry) In the WHO 2008 classification of leukemias of ambiguous lineage, the requirement for assigning more than one lineage to a single blast population has been revised ( Table 1). Cases having a score of more than 2 in both lineages are designated as biphenotypic. Antigens detected by flow cytometric immunophenotyping were assigned a score of 2, 1 or 0.5 depending on specificity of a particular antigen for myeloid, T lymphoid or B lymphoid lineage. MPAL or biphenotypic leukemia is defined when the score from two separate lineages is more than two. This scoring system is aimed at distinguishing cases of MPAL from those with aberrant expression i.e. The numerical scoring system for defining mixed phenotype acute leukemia (MPAL) was formulated by European Group for the the immunological classification of leukemias (EGIL). Ambiguous leukemias are rare and account for 4% of all cases of acute leukemia and frequently demonstrate an aggressive disease course with mean survival rates less than those of leukemias derived from single cell lineage.

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