Survival of patients with mixed phenotype acute leukemias: A large population-based study

Shi, Runhua; Munker, Reinhold

doi:10.1016/j.leukres.2015.03.012

Cited by 52 publications

(52 citation statements)

References 21 publications

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“…In terms of clinical endpoints, worse outcomes have been reported in adult patients diagnosed with MPAL using either the EGIL or the 2008 WHO criteria, compared to individuals diagnosed with AML or ALL [91921]. In all 4 groups in our study, the DFS was significantly shorter in MPAL patients than those of AML or ALL patients.…”

Section: Discussionmentioning

confidence: 51%

Mixed-phenotype acute leukemia: suboptimal treatment when the 2008/2016 WHO classification is used

et al. 2016

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BackgroundDifferent criteria have been used to diagnose mixed-phenotype acute leukemia (MPAL), which has impacted the number of individuals diagnosed with this pathology. Better outcomes have been reported when using acute lymphoblastic leukemia (ALL)-type chemotherapy in the treatment of MPAL.MethodsWe compared the outcome of 4 groups of patients with MPAL. Group 1 included patients diagnosed using the 2008/2016 World Health Organization (WHO) classification; group 2 included patients diagnosed using the European Group for the Immunological Characterization of Leukemias (EGIL) criteria; group 3 included patients diagnosed using either the EGIL or the 2008/2016 WHO criteria; and group 4 was comprised of patients diagnosed with MPAL using the EGIL classification only.ResultsWe found a significantly worse disease-free survival (groups 1-4) and overall survival (OS) (groups 2 and 3) when comparing MPAL patients to other acute leukemia (AL) patients. A significantly better OS was obtained in patients (groups 2-4) treated with ALL-type chemotherapy compared to acute myeloid leukemia (AML)-type regimens.ConclusionIn light of these results, and because a trend (P=0.06) was found with regard to a better OS in group 4 when compared to other AL patients, an argument can be made that the 2008/2016 WHO classification is underpowered to diagnose all MPAL cases, potentially resulting in the suboptimal treatment of some individuals with AL.

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Section: Discussionmentioning

confidence: 51%

Mixed-phenotype acute leukemia: suboptimal treatment when the 2008/2016 WHO classification is used

et al. 2016

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“…In the large population-based study MPAL make up only 0.6 % of all AL in comparison to previously reported 2-5% (ref. 31 ). Median age at diagnosis varies in series between 20 and 35 years with bimodal age distribution 14,21,27 .…”

Section: Discussionmentioning

confidence: 99%

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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“…1-5 MPAL are considered as “puzzling” due to their cell origin which may be a multipotent stem or progenitor cell. Originally, the European Group for the Immunologic Characterization of Leukemias (EGIL) established criteria for ABiL where points were assigned to specific markers of B lymphoid, T lymphoid and myeloid origin.…”

Section: Introductionmentioning

confidence: 99%

“…In published case series that range in patient numbers between 13 and 117, allogeneic hematopoietic stem cell transplantation (alloHCT) was performed in 7 – 61 %. 1 However, not all cases were classified according to WHO and in most reports, transplant outcomes were not reported. In one expert review, chemotherapy according to acute lymphoblastic leukemia (ALL), followed by alloHSCT was the preferred approach 8 , but definitive data are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…In earlier series treated with chemotherapy, or in countries with limited resources, a longer-term survival of 15- 35% was described. 1,14 Therefore, we investigated the outcome of 95 well documented cases of MPAL receiving alloHCT reported to the CIBMTR. We describe their characteristics, overall survival (OS), leukemia-free survival (LFS) and treatment-related complications and compare these with AML or ALL.…”

Section: Introductionmentioning

confidence: 99%

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Allogeneic Hematopoietic Cell Transplantation for Patients with Mixed Phenotype Acute Leukemia

Munker

Brazauskas

Wang

et al. 2016

Biology of Blood and Marrow Transplantation

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Acute biphenotypic leukemia or mixed phenotype acute leukemia (MPAL) is rare and considered high-risk. The optimal treatment and the role of allogeneic hematopoietic stem cell transplant (alloHCT) are unclear. Most prior case series include only modest numbers of transplanted patients. We analyzed the outcome of 95 carefully characterized alloHCT patients with MPAL reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) between 1996 and 2012. The median age was 20 years (range 1- 68). Among the 95 patients, 78 were in first complete remission (CR1) and 17 in CR2. Three-year overall survival (OS) 67% (95% confidence interval [CI] 57-76), leukemia-free survival (LFS) 56% (95% CI 46-66), relapse incidence 29% (95% CI 20-38) and non-relapse mortality 15% (95% CI 9-23) were encouraging. OS was best in younger patients (< 20), but no significant differences were observed between those 20-40 and > 40 years. A matched-pair analysis showed similar outcomes comparing MPAL cases to 375 acute myelogenous leukemia (AML) or 359 acute lymphoblastic leukemia (ALL) cases. MPAL patients had more acute and a non-significant increase of chronic graft-versus host disease (GVHD). No difference was observed between patients transplanted in CR1 versus CR2. AlloHCT is a promising treatment option for pediatric and adult patients with MPAL with encouraging long-term survival.

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Survival of patients with mixed phenotype acute leukemias: A large population-based study

Cited by 52 publications

References 21 publications

Mixed-phenotype acute leukemia: suboptimal treatment when the 2008/2016 WHO classification is used

Mixed-phenotype acute leukemia: suboptimal treatment when the 2008/2016 WHO classification is used

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

Allogeneic Hematopoietic Cell Transplantation for Patients with Mixed Phenotype Acute Leukemia

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