Blood Res.  2016 Dec;51(4):233-241. 10.5045/br.2016.51.4.233.

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

• Pomerantz
• Rodriguez-Rodriguez S
• Demichelis-Gomez R
• Barrera-Lumbreras G
• Barrales-Benitez O
• Lopez-Karpovitch X
• Aguayo-Gonzalez A

• KMID: 2364313
• DOI: http://doi.org/10.5045/br.2016.51.4.233

Abstract

BACKGROUND
Different 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.
METHODS
We 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.
RESULTS
We 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.
CONCLUSION
In 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.

Keyword

Mixed-phenotype acute leukemia; WHO classification; EGIL classification; Suboptimal treatment

MeSH Terms

Classification*
Disease-Free Survival
Drug Therapy
Humans
Leukemia*
Leukemia, Myeloid, Acute
Pathology
Precursor Cell Lymphoblastic Leukemia-Lymphoma
World Health Organization

Figure

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  Fig. 1 Overall survival of mixed-phenotype acute leukemia patients versus individuals with other acute leukemias in group 1 (A), group 2 (B), group 3 (C) and group 4 (D).

• 

  Fig. 2 Disease-free survival of mixed-phenotype acute leukemia patients versus individuals with other acute leukemias in group 1 (A), group 2 (B), group 3 (C) and group 4 (D).

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