Mixed Phenotype Acute Leukemia

IntroductionMixed phenotype acute leukemia (MPAL) is the combination of two leukemias which are acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). This illness is very rare and its symptoms are similar to other type of leukemia (fever, appetite loss, anemia). It can be diagnosed by flow cytometry on bone marrow. Here we are presenting case of child with MPAL.• Cases reportA 10_year_old male child complaining of fever, vomiting, diarrhea, stomachache and chest pain was admitted to our hospital. peripheral blood tests showed anemia, leukocytosis, thrombocytosis, decreased Hb and elevated PT and INR. EBV and CMV antibodies were reported negative. hepatosplenomegaly (spleen was measured 196 mm) was seen in abdominal ultrasonography.Bone marrow aspiration was compatible with mixed phenotype acute leukemia. He was diagnosed with biphenotype AML and Cell ALL and was referred to oncology department for induction chemotherapy. After first induction, no signs of remission were seen; So underwent another induction with REZ_BFM protocol. After administrating high dose of MTX he was transferred to ICU because of drug side effects, seizure and tumor lysis syndrome. Symptoms like seizure, infection, neutropenia and mucositis was managed and then he was transferred to oncology department again for HLA typing for BM transplantation consultation.• Discussion and ConclusionMixed phenotype acute leukemia is rare clinical entity and is more common in adults than children, but it can occur at any age. This leukemia is hard to treat because of its rapid growth and many complications can occur during the treatment phase so in child with mixed phenotype acute leukemia the survival rate is very low