Comparison of outcomes in mixed phenotype acute leukemia patients treated with chemotherapy and stem cell transplantation versus chemotherapy alone

Tian, Hong; Xu, Yang; Li, Liming; Yan, Litao; Jin, Zhengming; Tang, Xiaowen; Han, Yue; Fu, Zhengzheng; Qiu, Huiying; Sun, Aining; Wu, Depei

doi:10.1016/j.leukres.2016.04.002

Cited by 38 publications

(29 citation statements)

References 15 publications

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“…CNS prophylaxis/treatment should be a mandatory part of treatment strategy 15,18 . Reported results from case series indicate that allogeneic HCT could be a prospective treatment option for patients achieving CR compared with chemotherapy-only regiments 14,22,27 . Younger age is generally considered to be a favorable prognostic factor as it is associated with fewer comorbidities allowing use of an intensive treatment approach consisting of high dose chemotherapy followed by allogeneic HCT.…”

Section: Discussionmentioning

confidence: 99%

“…Among MPAL patients, B/myeloid is the most common immunophenotype 6,14,21,22 . Out of 100 patients included in the British study, B/myeloid, T/myeloid and B/T lymphoblastic immunophenotypes were identified in 59 (59%), 35 (35%) and 4 (4%) individuals, respectively.…”

Section: Immunophenotypic Findingsmentioning

confidence: 99%

“…The prognosis of patients is also affected by the selection of induction therapy, with induction therapy for ALL being more beneficial than that for AML, as well as of consolidation therapy, with better outcomes seen in patients undergoing allogeneic hematopoietic cell transplantation (HCT) (ref. 6,14,15,22 ).…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…The published data suggest better treatment outcomes resulting from induction therapy for ALL and combined AML/ALL-like protocols followed by allogeneic HCT (ref. 6,[14][15][16]22 ). In a study of 35 children with MPAL meeting the EGIL criteria, remission was achieved in 12/23 (52%) patients receiving AML induction therapy and 10/12 (82%) children treated according to an ALL protocol.…”

Section: Treatment Of Mpalmentioning

confidence: 99%

“…The 3-year overall survival differed significantly between the HCT and chemotherapy-only treated subgroups (77% vs. 16%) (ref. 22 ). The overall survival of patients undergoing allogeneic HCT was reported to be significantly longer than in case of those receiving consolidation chemotherapy (22 vs. 9 months) (ref.…”

Section: Treatment Of Mpalmentioning

confidence: 99%

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Mixed-phenotype acute leukemia: state-of-the-art of the diagnosis, classification and treatment

Čerňan¹,

Szotkowski²,

Pikalova³

2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Mixed-phenotype acute leukemia (MPAL) is a heterogeneous group of hematopoietic malignancies in which blasts show markers of multiple developmental lineages and cannot be clearly classified as acute myeloid or lymphoblastic leukemias. Historically, various names and classifications were used for this rare entity accounting for 2-5% of all acute leukemias depending on the diagnostic criterias used. The currently valid classification of myeloid neoplasms and acute leukemia published by the World Health Organization (WHO) in 2016 refers to this group of diseases as MPAL. Because adverse cytogenetic abnormalities are frequently present, MPAL is generally considered a disease with a poor prognosis. Knowledge of its treatment is limited to retrospective analyses of small patient cohorts. So far, no treatment recommendations verified by prospective studies have been published. The reported data suggest that induction therapy for acute lymphoblastic leukemia followed by allogeneic hematopoietic cell transplantation is more effective than induction therapy for acute myeloid leukemia or consolidation chemotherapy. The establishment of cooperative groups and international registries based on the recent WHO criterias are required to ensure further progress in understanding and treatment of MPAL. This review summarizes current knowledge on the diagnosis, classification, prognosis and treatment of MPAL patients.

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Section: Discussionmentioning

confidence: 99%

Section: Immunophenotypic Findingsmentioning

confidence: 99%

Section: Prognostic Factorsmentioning

confidence: 99%

Section: Treatment Of Mpalmentioning

confidence: 99%

Section: Treatment Of Mpalmentioning

confidence: 99%

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Mixed-phenotype acute leukemia: state-of-the-art of the diagnosis, classification and treatment

Čerňan¹,

Szotkowski²,

Pikalova³

2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Treatment of CD19‐positive mixed phenotype acute leukemia with blinatumomab

et al. 2018

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Mixed‐phenotype acute leukemia: A cohort and consensus research strategy from the Children’s Oncology Group Acute Leukemia of Ambiguous Lineage Task Force

Orgel

Alexander

Wood

et al. 2019

Cancer

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BACKGROUND:Optimal chemotherapy for treating mixed-phenotype acute leukemia (MPAL) and the role of hematopoietic stem cell transplantation (HSCT) remain uncertain. Major limitations in interpreting available data are MPAL's rarity and the use of definitions other than the currently widely accepted criteria: the World Health Organization 2016 (WHO2016) classification. METHODS: To assess the relative efficacy of chemotherapy types for treating pediatric MPAL, the Children's Oncology Group (COG) Acute Leukemia of Ambiguous Lineage Task Force assembled a retrospective cohort of centrally reviewed WHO2016 MPAL cases selected from banking studies for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Patients were not treated in COG trials; treatment and outcome data were captured separately. The findings were then integrated with the available, mixed literature to develop a prospective trial in pediatric MPAL. RESULTS: The central review confirmed that 54 of 70 cases fulfilled WHO2016 criteria for MPAL. ALL induction regimens achieved remission in 72% of the cases (28 of 39), whereas AML regimens achieved remission in 69% (9 of 13). The 5-year event-free survival (EFS) and overall survival (OS) rates for the entire cohort were 72% ± 8% and 77% ± 7%, respectively. EFS and OS were 75% ± 13% and 84% ± 11%, respectively, for those receiving ALL chemotherapy alone without HSCT (n = 21). CONCLUSIONS:The results of the COG MPAL cohort and a literature review suggest that ALL chemotherapy without HSCT may be the preferred initial therapy. A prospective trial within the COG is proposed to investigate this approach; AML chemotherapy and/or HSCT will be reserved for those with treatment failure as assessed by minimal residual disease. Embedded biology studies will provide further insight into MPAL genomics. Cancer 2020;126:593-601.

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Comparison of outcomes in mixed phenotype acute leukemia patients treated with chemotherapy and stem cell transplantation versus chemotherapy alone

Cited by 38 publications

References 15 publications

Mixed-phenotype acute leukemia: state-of-the-art of the diagnosis, classification and treatment

Mixed-phenotype acute leukemia: state-of-the-art of the diagnosis, classification and treatment

Treatment of CD19‐positive mixed phenotype acute leukemia with blinatumomab

Mixed‐phenotype acute leukemia: A cohort and consensus research strategy from the Children’s Oncology Group Acute Leukemia of Ambiguous Lineage Task Force

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