Requirements for assigning more than one lineage to a single blast population

Myeloid lineage

MPO (by flow cytometry, immunohistochemistry, or cytochemistry).

Monocytic differentiation (≥2 of the following: non-specific esterase, CD11c, CD14, CD64, lysozyme).

T cell lineage

Cytoplasmic CD3 (by flow cytometry with antibodies to CD3 epsilon chain. Immunohistochemistry using polyclonal anti-CD3 antibody may detect CD3 zeta chain, which is not T cell specific.)

Surface CD3 (rare in mixed-phenotype acute leukemias).

B cell lineage (multiple antigens required)

Strong CD19 with ≥1 of the following strongly expressed: CD79a, cytoplasmic CD22, CD10.

Weak CD19 with ≥2 of the following strongly expressed: CD79a, cytoplasmic CD22, CD10.

MPO: myeloperoxidase.

Reproduced with permission from: Swerdlow, SH, Campo, E, Harris, NL, Jaffe, ES, Pileri, SA, Stein, H, Thiele, J, Arber DA, Hasserjian RP, Le Beau MM, Orazi A, Siebert R. World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues, revised 4th edition. IARC, Lyon, 2017.

Graphic 117161 Version 1.0

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Requirements for assigning more than one lineage to a single blast population