Specific diagnostic workup in adult ALL
| . | Recommendation . | Outputs . |
|---|---|---|
| Morphology | Mandatory | Defines infiltration (>25% required for a diagnosis of ALL vs lymphoblastic lymphoma) |
| Allows a differential diagnosis with AML (MPO– vs + MPO+) | ||
| Recognizes L3 (Burkitt-type) subsets | ||
| Flow cytometry | Mandatory | Allows a differential diagnosis with AML |
| Permits to define the cell of origin | ||
| Permits to define the stage of differentiation | ||
| MPO∗ | Mandatory | Allows a differential diagnosis with AML. |
| B-lineage ALL∗: CD19, cCD79a, c/sCD22 (minimal requirement), TdT, CD10, CD20, cIgM, sIg (kappa or lambda) | Mandatory | Pro-B: CD19/CD79a/cCD22+/CD10– (B-I), NG2 |
| Common: CD10+/cIgM– (B-II) | ||
| Pre-B: cIgM+/sIg– (B-III) | ||
| Mature: sIg+ (B-IV), CD20+ | ||
| T-lineage ALL∗: c/sCD3, CD7 (minimal requirement), TdT, CD1a, CD2, CD5, CD4, CD8, TCR α/β or γ/δ | Mandatory | Pro-T: cCD3/CD7+ (T-I) |
| Pre-T: CD2/CD5+ (T-II) | ||
| Cortical-T: CD1a+ (T-III) | ||
| Mature-T: sCD3+/CD1a– (T-IV) | ||
| Molecular genetics | Mandatory | t(9;22)/Ph+/BCR::ABL1 |
| t(4;11)+/KMT2Ar | ||
| t(1;19)+/TCF3::PBX1 | ||
| Other high-risk cytogenetics | ||
| MRD (molecular or MFC) | Mandatory | Individual MRD assay for further follow-up |
| Extended genomics (GEP, CNA, WES, WGS, NGS) | In clinical trials and for research purposes | Identification of novel subgroups with prognostic/biologic significance |
| Identification of molecular targets for targeted therapies |
| . | Recommendation . | Outputs . |
|---|---|---|
| Morphology | Mandatory | Defines infiltration (>25% required for a diagnosis of ALL vs lymphoblastic lymphoma) |
| Allows a differential diagnosis with AML (MPO– vs + MPO+) | ||
| Recognizes L3 (Burkitt-type) subsets | ||
| Flow cytometry | Mandatory | Allows a differential diagnosis with AML |
| Permits to define the cell of origin | ||
| Permits to define the stage of differentiation | ||
| MPO∗ | Mandatory | Allows a differential diagnosis with AML. |
| B-lineage ALL∗: CD19, cCD79a, c/sCD22 (minimal requirement), TdT, CD10, CD20, cIgM, sIg (kappa or lambda) | Mandatory | Pro-B: CD19/CD79a/cCD22+/CD10– (B-I), NG2 |
| Common: CD10+/cIgM– (B-II) | ||
| Pre-B: cIgM+/sIg– (B-III) | ||
| Mature: sIg+ (B-IV), CD20+ | ||
| T-lineage ALL∗: c/sCD3, CD7 (minimal requirement), TdT, CD1a, CD2, CD5, CD4, CD8, TCR α/β or γ/δ | Mandatory | Pro-T: cCD3/CD7+ (T-I) |
| Pre-T: CD2/CD5+ (T-II) | ||
| Cortical-T: CD1a+ (T-III) | ||
| Mature-T: sCD3+/CD1a– (T-IV) | ||
| Molecular genetics | Mandatory | t(9;22)/Ph+/BCR::ABL1 |
| t(4;11)+/KMT2Ar | ||
| t(1;19)+/TCF3::PBX1 | ||
| Other high-risk cytogenetics | ||
| MRD (molecular or MFC) | Mandatory | Individual MRD assay for further follow-up |
| Extended genomics (GEP, CNA, WES, WGS, NGS) | In clinical trials and for research purposes | Identification of novel subgroups with prognostic/biologic significance |
| Identification of molecular targets for targeted therapies |
c, cytoplasmic; GEP, gene expression profiling; MPO, myeloperoxidase; s, surface; WES, whole exome sequencing; WGS, whole genome sequencing.
MPAL: myeloid myeloperoxidase or at least 2 of the following antigens: nonspecific esterase, CD11c, CD14, CD64, and lysozyme; B-lineage: strong CD19 expression plus at least 1 of the following strongly expressed antigens: CD79a, cyCD22, CD10, or weak CD19, with at least 2 of the following strongly expressed antigens: CD79a, cytCD22, CD10; and T-lineage: cCD3 or rarely sCD3.