{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:17:41Z","timestamp":1790914661932,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T00:00:00Z","timestamp":1667347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Myeloperoxidase (MPO) is considered a specific marker of myeloid\/non\u2010monocytic lineage in the diagnosis of mixed phenotype acute leukemia (MPAL). However, the clinical significance of isolated dim MPO expression in otherwise typical B lymphoblastic leukemia (B\u2010ALL; referred to as B\/myeloid MPAL<jats:sup>isoMPO<\/jats:sup>) in adult patients is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We compared flow cytometric immunophenotype and clinicopathological findings among cases of B\/myeloid MPAL<jats:sup>isoMPO<\/jats:sup> (<jats:italic>n<\/jats:italic>\u00a0=\u00a013), other MPAL subtypes (<jats:italic>n<\/jats:italic>\u00a0=\u00a010, B\/myeloid and T\/myeloid MPAL), B\u2010ALL (<jats:italic>n<\/jats:italic>\u00a0=\u00a064), and acute myeloid leukemia (AML, <jats:italic>n<\/jats:italic>\u00a0=\u00a058), using the 2016 WHO classification. For MPAL cases, MPO was reported as the percent of MPO positive blasts and its intensity (dim or moderate\/strong). The pattern of heterogenous antigen expression (inversely coordinated expression between myeloid and lymphoid markers and cell size) was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Cases of B\/myeloid MPAL<jats:sup>isoMPO<\/jats:sup> showed a fairly homogenous single B\u2010lineage blast population with dim MPO expression whereas cases of other MPAL subtypes displayed heterogeneous antigen expression and moderate\/strong MPO expression. The percent of MPO positive blasts in these two groups was similar. Expressions of CD15, CD117, and monocytic markers were more common in other MPAL than in B\/myeloid MPAL<jats:sup>isoMPO<\/jats:sup>. B\/myeloid MPAL<jats:sup>isoMPO<\/jats:sup> patients had similar overall and leukemia free survivals as B\u2010ALL patients and better than other MPAL patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is the first study to investigate the clinical significance of adult B\/myeloid MPAL<jats:sup>isoMPO<\/jats:sup> using the 2016 WHO classification. Our results suggest that B\/myeloid MPAL<jats:sup>isoMPO<\/jats:sup> clinically behaves more similarly to B\u2010ALL than to other MPAL subtypes, supporting the 2016 WHO classification to segregate this entity from other MPAL subtypes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijlh.13988","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T06:29:58Z","timestamp":1667456998000},"page":"170-178","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Adult mixed phenotype acute leukemia (<scp>MPAL<\/scp>): B\/myeloid <scp>MPAL<sup>isoMPO<\/sup><\/scp> is distinct from other <scp>MPAL<\/scp> subtypes"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4250-3891","authenticated-orcid":false,"given":"Olga K.","family":"Weinberg","sequence":"first","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Dennis","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid","family":"Zia","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Department of Laboratory Medicine Zhongshan Hospital Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasad","family":"Koduru","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2001-4031","authenticated-orcid":false,"given":"Hung S.","family":"Luu","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franklin","family":"Fuda","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5638-4371","authenticated-orcid":false,"given":"Weina","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,2]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"149","volume-title":"WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues","author":"Borowitz MJ","year":"2008"},{"key":"e_1_2_10_3_1","first-page":"180","volume-title":"WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, Revised 4th Edition","author":"Borowitz MJ","year":"2017"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.path.2019.03.008"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11912-022-01252-w"},{"issue":"10","key":"e_1_2_10_6_1","first-page":"1783","article-title":"Proposals for the immunological classification of acute leukemias. European Group for the Immunological Characterization of Leukemias (EGIL)","volume":"9","author":"Bene MC","year":"1995","journal-title":"Leukemia"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-03-643544"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqx021"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/cyto.b.21966"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-09-807602"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqw178"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2021.106584"},{"issue":"2","key":"e_1_2_10_13_1","article-title":"Mixed phenotype acute leukemia in adult: a single institution experience and recommendation on further refinement of classification criteria","volume":"29","author":"Dennis J","year":"2016","journal-title":"Mod Pathol"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4939-7142-8_4"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/cyto.b.21155"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/cyto.b.21159"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/cyto.b.21783"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/cyto.b.21072"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.17210"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12277"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01613-1"}],"container-title":["International Journal of Laboratory Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijlh.13988","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ijlh.13988","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijlh.13988","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T22:52:36Z","timestamp":1692571956000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijlh.13988"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,2]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1111\/ijlh.13988"],"URL":"https:\/\/doi.org\/10.1111\/ijlh.13988","archive":["Portico"],"relation":{},"ISSN":["1751-5521","1751-553X"],"issn-type":[{"value":"1751-5521","type":"print"},{"value":"1751-553X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,2]]},"assertion":[{"value":"2022-07-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}