Biphenotypic acute leukaemia


Biphenotypic acute leukaemia (BAL) is a rare form of leukemia that has myeloid and lymphoid features. It is a subtype of "leukemia of ambiguous lineage.

It is an uncommon disease and as strict diagnostic criteria have only recently been established, the precise incidence among acute leukaemias is uncertain, although it is likely to account for approximately 5% of all acute leukaemias. BAL can be de novo or secondary to previous cytotoxic therapy. It has been included in the WHO classification of haemopoietic malignancies as acute leukaemia of ambiguous lineage.


  • Panctyopenia
  • Reduced appetite
  • Enlarged liver
  • Fever
  • Bleeding problems
  • Easy bruising
  • Fatigue
  • Pallor
  • Weight loss
  • Enlarged spleen
  • Petechiae


These home medical tests may be relevant to Acute biphenotypic leukemia: * Colon & Rectal Cancer: Home Testing * Home Colorectal Cancer Tests * Home Fecal Occult Bleeding Tests


The prognosis of BAL in adults is worse than acute myeloid leukaemia (AML) or acute lymphoid leukaemia (ALL). Four year overall survival has been quoted at 8%, although the numbers in this study are low. The most important good prognostic features emerging from limited data are age (<60 years), absence of the Philadelphia chromosome and achievement of complete remission. BAL is associated with over-expression of P glycoprotein (Pgp). As Pgp phenotype is often associated with treatment outcome in patients with acute leukaemia, it is likely that over-expression may worsen the prognosis in BAL.


BAL has proven to be very difficult to treat with many cases being resistant to induction chemotherapy and those that enter remission have a high risk of relapse. There is no agreement on how the disease should be treated. The majority of patients receive treatment according to the morphology of the blasts, with either AML or ALL induction. If patients enter complete remission, consideration should be given to consolidation with stem cell transplantation.