Case Report: Acute Lymphoblastic Leukemia (ALL) with Suspect of Mixed Phenotype Acute Leukemia (MPAL) B/T ALL

ABSTRACT

Introduction. Acute lymphoblastic leukemia (ALL) is a malignancy of lymphoblast, immature lymphoblast continuously multiply and are overproduced in the bone marrow. ALL L2 is characterized by larger cells, an irregular-shaped nucleus, and variation in nuclei-cytoplasm ratio. ALL L2 has a poorer prognosis than L1. ALL L2 is common in adults.

Case. A 3-year-old child was brought to hospital with the complaints of fever, epistaxis, and fatigue for about 4 days. The laboratory findings: Hb 10.5 g/dl, leukocytes 21,600/µl, thrombocytes 37,000/µl, Hct 30.3 %, MCV 78.1 fl, MCH 27.1 pg, reticulocytes 0.13%, differential count -/-/4/-/26/- lymphoblast 70%. The bone marrow aspirate result: infiltration of 90% lymphoblast with various size and prominent nucleoli.  Immunophenotyping result:  One population of blast with expression of all panel (CD5, CD7, CD19, and CD20) positive (> 20%. So that his blast isolate  had the surface antigen expression of 2  hematopoietic (B and T lymphoid). This could be classified as mixed phenotype acute leukemia (MPAL)B/T ALL.

Conclussion. Based on clinical findings, BMP, and immunophenotyping patient was suffered from ALL-L2, might be MPAL B/T ALL. The other CD markers like MPO and cCD3 are needed to make diagnosis of MPAL B/T ALL according to EGIL score and WHO criteria. 

Key words: ALL L2; MPAL B/T ALL

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