A Case Report on Diagnostic, Genetic and Therapeutic Challenges in Mixed Phenotype Acute Leukemia

We report a rare B/T/myeloid MPAL case with MLL-AF4 gene rearrangement, successfully treated with an AML-oriented protocol, after failing leukemic blast clearing as a result of pre-phase steroid treatment. MPAL diagnosis is based on the combined expression of lymphoid, either B- or T-, and myeloid markers, potentially showing a B/T lymphoid, B/myeloid, T/myeloid, or even and more rarely, a trilineage B/T/myeloid commitment. A 34-year-old Palestinian social worker was admitted at the Augusta Victoria Hospital on September 2018 because of pancytopenia, multiple bluish-to-purple skin lesions, gingival bleeding, fever and night sweats. The patient was readmitted two weeks later for consolidation chemotherapy with high dose cytarabine (HIDAC) 3000 mg/m2 days 1, 3, and 5. ALL- oriented chemotherapy has been reported to be a superior treatment, steroid response could guide to switching to an AML-based protocol.