Biphenotypic acute leukaemia (BAL) is an uncommon type of leukemia which arises in multipotent progenitor cells which have the ability to differentiate into both myeloid and lymphoid lineages. It is a subtype of "leukemia of ambiguous lineage".The direct reasons leading to BAL are still not clear. BAL can be de novo or secondary to previous cytotoxic therapy. Many factors, such viruses, hereditary factors, and radiation, might have a relationship with BAL. BAL is hard to treat. Usually the chemotherapy is chosen according to the morphology of the blast (ALL or AML). A blood-forming stem-cell transplantation is highly recommended. About 5% of acute leukaemia cases are BAL. BAL can occur in all ages of people but occurs more in adults than in children. Signs and symptoms
BAL has similar symptoms to other types of leukemia, but they are usually more serious. Symptoms caused by bone marrow damage
Bruising, spotting: the reason is lack of platelets. it is very common in BAL patients, most of patients die due to the
A low level of red blood cells in the bloodstream: Because the decline of hematopoietic function, need blood transfusion therapy
Persistent fever, infection prolonged healing:
Diffuse hemorrhage: which is dangerous and might lead to death. Symptoms caused by blood cancer cells infiltration into tissues:
Swollen lymph nodes
Joint pain
Swelling of the gums
Enlargement of the liver and spleen
Headache and vomiting: blood cancer infiltration into the wear performance of the central nervous system. Skin lumps: Because look was slightly green, also known as the "Green tumor."
Such as t(8;21), t(15;17), del(6q), del(12p), t(x;12) and t(14;19). In BAL patients, it is prone to bruising, spotting, which is due to megakaryocytes that could produce platelets decrease, resulting in a lack of platelets. Anemia: reduction metrocytes that could produce red blood cells, resulting in a lack of red blood cells. Patients are prone to asthma and dizziness in walking or exercise. Persistent fever, infection prolonged healing: Most of the white blood cells are leukemia cells, no normal function, leading to decreased immunity, susceptible to infection. Diagnosis
Following observation of the symptoms, the patients need to get complete blood counts and a bone marrow examination. If the patient has leukemia, the morphology and immunophenotype check is needed to make sure the type of leukemia. The morphology of the blast in BAL is not certain. The cells could display both myeloid lineage and lymphoid or undifferentiated morphology. Therefore, the diagnosis cannot based on the morphology result. The immunophenotype check is the most important basis of the diagnosis of BAL. Before 2008, the diagnosis of BAL was based on a score system proposed by the  European Group for the Immunological Classification of Leukemias (EGIL) which could differentiate from other kinds of acute leukemia. The table shows this method. If the score of only one lineage is higher than 2, the acute leukemia could be acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL).