Biphenotypic acute leukemia: A case report

Alessandra Zucchini, P. P. Fattori, F. Lanza, L. Ferrari, L. Bagli, M. Imola, A. Ravaioli, S. Papa

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Abstract

We describe an uncommon case of acute leukemia in which leukemic blasts expressed myeloid antigens and cyCD79α molecule. In this 49-year old male patient, two distinct blast populations were detected in peripheral blood and bone marrow samples: one of small size resembling lymphoblasts and another with pink cytoplasmic granules resembling myeloblasts. Cytochemical reaction for myeloperoxidase was negative in both cell types. Conventional cytogenetic analysis showed a normal karyotype (46 XY) in all metaphases studied, while gene rearrangement analysis by seminested PCR of the immunoglobulin heavy chain (Ig-H) and T-cell-γ chain (TCR-γ) receptor, showed a germline configuration of the TCR and clonal rearrangement of Ig-H chain genes. Multicolour cytofluorimetric analysis showed that bone marrow and peripheral blood blasts expressed CD19, CD79α bright, CD22 and terminal deoxynucleotidyl transferase (TdT) as lymphoid markers, CD13, CD117, CD15 as myeloid markers, CD34, HLA-DR as stem cell markers. CD33 myeloid antigen was expressed by 50% of the blastic population. No differences in the immunophenotypic profile were detected in the two blast populations which were identified by morphology. According to EGIL (European Group of Immunological Classification of Leukemias) and WHO (World Health Organization) criteria, a diagnosis of biphenotypic acute leukemia (BAL) was made. The patient was treated with AML induction therapy followed by autologous stem cell transplantation, but relapse free survival was 6 months. The patient died a few weeks later due to unresponsiveness to salvage chemotherapy regimens. We conclude that patients with BAL should have a risk stratification with treatment tailored to their immunophenotype and gene rearrangement profiles.

Original languageEnglish
Pages (from-to)387-391
Number of pages5
JournalJournal of Biological Regulators and Homeostatic Agents
Volume18
Issue number3-4
Publication statusPublished - Jul 2004

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Keywords

  • Biphenotypic acute leukemia
  • Immunoglobulin gene rearrangement
  • Multicolor flow cytometry
  • Worse prognosis

ASJC Scopus subject areas

  • Immunology
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Physiology (medical)
  • Medicine (miscellaneous)
  • Physiology
  • Agricultural and Biological Sciences(all)

Cite this

Zucchini, A., Fattori, P. P., Lanza, F., Ferrari, L., Bagli, L., Imola, M., Ravaioli, A., & Papa, S. (2004). Biphenotypic acute leukemia: A case report. Journal of Biological Regulators and Homeostatic Agents, 18(3-4), 387-391.