ENIGMA Pre-Test

The most common immunophenotypic finding in MPAL

• B/ myeloid

• T/ myeloid

• B/T lymphoblastic

• Trilineage co-expression

True of mixed phenotype acute leukemia EXCEPT:

• CNS involvement are relatively infrequent

• There is no difference in survival between patients who underwent HSCT in first or second CR

• Blinatumomab and Donor lymphocyte infusion may be considered in relapsed MPAL patients

• Has bimodal age distribution

Most sensitive test to detect myeloperoxidase

• Enzyme cytochemistry

• Flow cytometry

• IHC

• RT-PCR

TRUE of Mixed phenotypic leukemia except:

• Median age at diagnosis is 20-30 years old

• Slight female predominance

• Incidence higher in adults than children

• Bimodal age distribution

True in the treatment of mixed phenotypic leukemia until first remission

• Use ALL based regimen

• Use AML based regimen

• Use ALL based regimen followed by HSCT

• Use AML based regimen followed by HSCT

Mutation in this signaling were previously described in the context of lineage switch from AML to T-ALL

• NOTCH1

• NOTCH2

• NOTCH3

• NOTCH4

Diagnosis of Mixed phenotypic acute leukemia according to the European Group for Immunological characterization of Leukemias

• Score >1 for myeloid and/ lymphoid lineages

• Score >2

• Score >4

• Score > 6

Treatment guidelines for MPAL is not clearly established

• TRUE

• FALSE

Patients with Philadelphia positive (Ph+) MPAL who received TKIs had a significant reduction in the risk of death in comparison to Ph (-) MPAL patients

• TRUE

• FALSE

Cases of CNS involvement are relatively frequent in MPAL

• TRUE

• FALSE