T-lymphoblastic Leukemia/Lymphoma

doi:10.1017/9781009397797.022

Chapter 22 - T-lymphoblastic Leukemia/Lymphoma

from Section 3 - Acute Lymphoblastic Leukemia/Lymphoma

Published online by Cambridge University Press: 20 May 2026

Sa A. Wang

Edited by

Wei Wang and

Sa A. Wang

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Wei Wang: Affiliation:
The University of Texas MD Anderson Cancer Center
Sa A. Wang: Affiliation:
The University of Texas MD Anderson Cancer Center

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Summary

This chapter includes the diagnosis of T-lymphoblastic leukemia/lymphoma (T-ALL/LBL) and measurable disease detection (MRD) post therapy. Flow cytometry immunophenotyping is essential in establishing a diagnosis of T-ALL/LBL and subclassifying by their maturation into early T-phenotype (ETP), near ETP, cortical thymic T-, and mature T-ALL/LBL. Recent advancement in genetic classifications of T-ALL/LBL shows high-risk genetic alterations are highly associated with ETP-ALL. T-ALL/LBL show overlap features with acute undifferentiated leukemia, mixed phenotype T/myeloid, T/B leukemia, indolent T-lymphoblastic proliferation, and mature T-cell lymphoma/leukemia. The features pertinent for differential diagnosis are illustrated. For MRD, the discussion includes the principles and strategies, analysis and interpretations, mimics and common pitfalls. The pros and cons of flow cytometry MRD are compared with molecular MRD, including NGS sequencing (Clonoseq). Although currently there is no FDA-approved CAR T-therapy for T-ALL, promising products such as CD7-CAR and CD5-CAR have been used in clinical trials. Strategies in MRD and challenges in the era of targeted therapy are discussed.

Keywords

T-lymphoblastic leukemia/lymphoma T-ALL ETP BCL11b-activated thymoma genetics Indolent T-lymphoblastic proliferation Clonoseq CD7-CART immature NK cells

Information

Type: Chapter
Information: Flow Cytometry in Hematolymphoid Neoplasms
A Comprehensive and Practical Guide to Diagnosis
, pp. 205 - 222
DOI: https://doi.org/10.1017/9781009397797.022 [Opens in a new window]
Publisher: Cambridge University Press
Print publication year: 2026

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