Acute myeloid/T-lymphoblastic leukaemia (AMTL): a distinct category of acute leukaemias with common pathogenesis in need of improved therapy

Br J Haematol. 2018 Mar;180(6):919-924. doi: 10.1111/bjh.15129. Epub 2018 Feb 14.


Advances in the classification of acute leukaemias have led to improved outcomes for a substantial fraction of patients. However, chemotherapy resistance remains a major problem for specific subsets of acute leukaemias. Here, we propose that a molecularly distinct subtype of acute leukaemia with shared myeloid and T cell lymphoblastic features, which we term acute myeloid/T-lymphoblastic leukaemia (AMTL), is divided across 3 diagnostic categories owing to variable expression of markers deemed to be defining of myeloid and T-lymphoid lineages, such as myeloperoxidase and CD3. This proposed diagnostic group is supported by (i) retained myeloid differentiation potential during early T cell lymphoid development, (ii) recognition that some cases of acute myeloid leukaemia (AML) harbour hallmarks of T cell development, such as T-cell receptor gene rearrangements and (iii) common gene mutations in subsets of AML and T cell acute lymphoblastic leukaemia (T-ALL), including WT1, PHF6, RUNX1 and BCL11B. This proposed diagnostic entity overlaps with early T cell precursor (ETP) T-ALL and T cell/myeloid mixed phenotype acute leukaemias (MPALs), and also includes a subset of leukaemias currently classified as AML with features of T-lymphoblastic development. The proposed classification of AMTL as a distinct entity would enable more precise prospective diagnosis and permit the development of improved therapies for patients whose treatment is inadequate with current approaches.

Keywords: acute leukaemia; acute lymphoblastic leukaemia; acute myeloid leukaemia; classifications.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Humans
  • Leukemia, Myelomonocytic, Acute* / classification
  • Leukemia, Myelomonocytic, Acute* / diagnosis
  • Leukemia, Myelomonocytic, Acute* / genetics
  • Leukemia, Myelomonocytic, Acute* / therapy
  • Leukemia, T-Cell* / classification
  • Leukemia, T-Cell* / diagnosis
  • Leukemia, T-Cell* / genetics
  • Leukemia, T-Cell* / therapy
  • Myeloid Cells
  • Neoplasm Proteins / genetics
  • Precursor Cells, T-Lymphoid


  • Neoplasm Proteins