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Updated: Jun 3, 2026
Assessment of the Metabolic Profile of Primary Leukemia Cells
Published on: November 21, 2018
[Study on the clinical characteristics of 32 patients with mixed phenotype acute leukemia]
Yan-ming Zhang1, De-pei Wu, Ai-ning Sun
1Department of Hematology, First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou 215006, China.
Objective:
To investigate the clinical and biological characteristics and prognosis of mixed phenotype acute leukemia (MPAL).
Methods:
Thirty two patients were diagnosed as MPAL by bone marrow examination, immunophenotyping, cytogenetic and molecular assay and were treated with combined chemotherapy regimens for both acute lymphoblastic and acute myeloid leukemia. Two cases were received allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Results:
(1) The incidence of MPAL in acute leukemias was 2.6%. There were 16 cases (50.0%) of mixed myeloid and B-lymphoid (M/B), 14(43.8%) myeloid and T-lymphoid (M/T), one each (3.1%) of trilineage (M/B/T) and B- and T-lymphoid (B/T) phenotype. (2) The positive rates of CD34 and HLA-DR were 87.5% and 62.5%, respectively. (3) Abnormal karyotypes were detected in 70.0% of 30 MPAL patients, which were structural and numerical abnormalities including t(9;22), 11q23 and complex karyotypes. (4) The total complete remission (CR) rate was 75.0% and the overall survival (OS) and disease-free survival (DFS) at 2 years were 14.8% and 14.2% respectively. The CR rates for M/B and M/T cases were 75.0% and 71.4% respectively. No statistical difference was observed in OS and DFS between M/B and M/T cases.
Conclusions:
MPAL is a rare type of acute leukemia with a high heterogeneity. The unfavorable indicators of MPAL may be factors such as abnormal karyotypes, high expression of CD34 and extramedullary infiltration. Combined regimens and more intensive therapy including allo-HSCT might contribute to improving survival.
Insights
Mixed phenotype acute leukemia (MPAL) is rare and heterogeneous. Intensive chemotherapy and allogeneic stem cell transplantation (allo-HSCT) may improve survival for MPAL patients with unfavorable indicators.
Area of Science:
- Hematology
- Oncology
- Leukemia Research
Context:
- Mixed phenotype acute leukemia (MPAL) represents a rare and diagnostically challenging subtype of acute leukemia.
- Understanding the clinical and biological heterogeneity of MPAL is crucial for optimizing treatment strategies.
- Previous studies have highlighted the complex nature of MPAL, necessitating further investigation into its characteristics and prognosis.
Purpose:
- To comprehensively investigate the clinical and biological characteristics of MPAL.
- To evaluate the prognostic factors influencing patient outcomes in MPAL.
- To assess the efficacy of current treatment regimens and explore potential improvements for MPAL.
Summary:
- This study analyzed 32 MPAL patients, revealing an incidence of 2.6% among acute leukemias.
- The predominant subtypes were mixed myeloid and B-lymphoid (M/B) (50.0%) and myeloid and T-lymphoid (M/T) (43.8%).
- High rates of CD34 (87.5%) and HLA-DR (62.5%) expression were observed, with 70.0% of patients exhibiting abnormal karyotypes. Complete remission (CR) was achieved in 75.0% of cases, but 2-year overall survival (OS) and disease-free survival (DFS) were low at 14.8% and 14.2%, respectively.
Impact:
- MPAL is characterized by significant heterogeneity, with abnormal karyotypes, high CD34 expression, and extramedullary infiltration identified as potential unfavorable prognostic indicators.
- Combined chemotherapy regimens and intensified therapeutic approaches, including allogeneic hematopoietic stem cell transplantation (allo-HSCT), hold promise for improving survival outcomes in MPAL.
- This research contributes to a better understanding of MPAL, guiding future therapeutic development and clinical management for this rare leukemia subtype.
