Table 1.

Acute leukemia of ambiguous lineage entities

Acute leukemia of ambiguous lineage
MPAL with defining genetic alterations 
MPAL with BCR::ABL1 
MPAL with t(v;11q23.3); KMT2A rearranged 
MPAL with ZNF384 rearrangement 
MPAL with BCL11B activation 
MPAL with defining immunophenotypic changes 
B/myeloid MPAL 
T/myeloid MPAL 
B/T/myeloid MPAL 
B/T MPAL 
Acute undifferentiated leukemia (AUL)  
ALAL, NOS  
Acute leukemia of ambiguous lineage
MPAL with defining genetic alterations 
MPAL with BCR::ABL1 
MPAL with t(v;11q23.3); KMT2A rearranged 
MPAL with ZNF384 rearrangement 
MPAL with BCL11B activation 
MPAL with defining immunophenotypic changes 
B/myeloid MPAL 
T/myeloid MPAL 
B/T/myeloid MPAL 
B/T MPAL 
Acute undifferentiated leukemia (AUL)  
ALAL, NOS  

NOS, not otherwise specified.

AUL is defined by a lack of lineage-specific markers (as outlined in Table 2). Based on a recent multiinstitutional study, cases with a partial or single full myeloid marker can be considered as AUL.11 Cases with immunophenotype of AUL but with cytogenetic abnormalities and molecular findings diagnostic of AML with myelodysplasia-related cytogenetic abnormalities or AML with myelodysplasia-related mutation should be diagnosed as AML.

Rare cases may fulfill neither the criteria for MPAL nor acute leukemia of a single lineage or may lack all the lineage-specific markers of Table 2. Such cases are best referred to as ALAL, NOS.

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