Fuda Franklin, Chen Weina
Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Cancers (Basel). 2025 Mar 3;17(5):871. doi: 10.3390/cancers17050871.
Acute leukemia of ambiguous lineage (ALAL) includes mixed-phenotype acute leukemia (MPAL), which exhibits immunophenotypic evidence of differentiation along more than one cell lineage, and acute undifferentiated leukemia (AUL), which lacks sufficient immunophenotypic differentiation along any cell lineage. This review provides an overview of ALAL, emphasizing the central role of flow cytometric analysis in its diagnostic workflow. It primarily focuses on MPAL, addressing updated classification and diagnostic criteria by the WHO-HEM5 and the ICC, including both genetically defined and phenotypically defined MPAL. The article provides a detailed review of the MPAL lineage assignment criteria with an illustrative description of a series of MPAL cases. Future studies are needed to reconcile the different criteria used in these two classifications. Continuously expanded molecular studies are expected to provide a genomic and lineage-associated framework for the classification of ALAL with clinical relevance in the diagnosis and therapy selection.
模糊谱系急性白血病（ALAL）包括混合表型急性白血病（MPAL），其表现出沿多个细胞谱系分化的免疫表型证据，以及急性未分化白血病（AUL），其缺乏沿任何细胞谱系的充分免疫表型分化。本综述概述了ALAL，强调了流式细胞术分析在其诊断流程中的核心作用。它主要关注MPAL，阐述了世界卫生组织血液学分类第5版（WHO-HEM5）和国际癌症分类（ICC）的更新分类及诊断标准，包括基因定义和表型定义的MPAL。本文详细回顾了MPAL谱系归属标准，并对一系列MPAL病例进行了示例性描述。未来需要开展研究以协调这两种分类中使用的不同标准。不断扩展的分子研究有望为具有临床诊断和治疗选择相关性的ALAL分类提供基因组和谱系相关框架。
