Flow cytometry immunophenotyping has a well-established role in the diagnosis and classification of ALL. It is used to distinguish ALL from minimally differentiated AML and to classify ALL into T-cell, B-cell, and various precursor B-cell immunological subtypes, which have prognostic and therapeutic implications.27 Mature B-cell ALL has characteristic morphological, immunophenotypic, karyotypic, and clinical features, while precursor B-cell and T-cell ALLs are morphologically indistinguishable. Precursor B-cell ALL is an umbrella term that covers leukemias of immature B cells, at different maturational stages, often termed pro-B-cell ALL, early-pre-B-cell ALL, and pre-B-cell ALL.28,29

T-ALL is simply classified into T stem cell leukemia and common T-ALL.29 Numerous efforts to correlate clinical outcome in T-cell ALL with the stage of maturation have yielded inconsistent results,12,13 suggesting a minor influence of T-cell maturation on treatment responsiveness.17,30

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