Where does transformation occur in acute leukemia?

We studied 43 consecutive cases of acute leukemia for evidence of hybrid leukemia including biphenotypic or bilineal involvement. Twenty-two were initially diagnosed as acute lymphoblastic leukemia (ALL) and 21 as acute myelogenous leukemia (AML). Techniques included morphology, cytochemistry, immune phenotyping and cytogenetics. Thirty-one cases seemed restricted to one lineage. Twelve cases showed involvement of both lymphoid and myeloid cells. Dual staining immune phenotyping showed coexpression of diverse lineage markers. These data indicate a considerable proportion of unselected cases of acute leukemia are hybrid leukemias. These data are consistent with the notion that transformation frequently occurs in a stem or progenitor cell.