Mixed-phenotype acute leukemia: suboptimal treatment when the 2008/2016 WHO classification is used
Alan Pomerantz1, Sergio Rodriguez-Rodriguez1, Roberta Demichelis-Gomez2
1Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico.; Faculty of Health Sciences, Universidad Anahuac Mexico Norte, Huixquilucan, State of Mexico, Mexico.
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.
Insights
Diagnosing mixed-phenotype acute leukemia (MPAL) varies, impacting treatment. Acute lymphoblastic leukemia (ALL)-type chemotherapy shows better outcomes for MPAL patients compared to acute myeloid leukemia (AML)-type regimens.
Area of Science:
- Hematology
- Oncology
- Leukemia Research
Background:
- Mixed-phenotype acute leukemia (MPAL) diagnosis lacks standardized criteria, affecting patient identification and treatment.
- Previous studies suggest improved outcomes for MPAL patients treated with acute lymphoblastic leukemia (ALL)-type chemotherapy.
Purpose of the Study:
- To compare the outcomes of MPAL patients diagnosed using different criteria.
- To evaluate the effectiveness of ALL-type versus acute myeloid leukemia (AML)-type chemotherapy in MPAL treatment.
Main Methods:
- Four groups of MPAL patients were analyzed based on diagnostic criteria: 2008/2016 World Health Organization (WHO), European Group for the Immunological Characterization of Leukemias (EGIL), combined EGIL/WHO, and EGIL-only.
- Patient outcomes, including disease-free survival and overall survival (OS), were compared.
Main Results:
- MPAL patients exhibited significantly worse disease-free survival and overall survival (OS) compared to other acute leukemia (AL) patients.
- Patients treated with ALL-type chemotherapy demonstrated significantly better OS than those receiving AML-type regimens.
Conclusions:
- The 2008/2016 WHO classification may underdiagnose MPAL, potentially leading to suboptimal treatment.
- EGIL criteria or combined approaches may improve MPAL diagnosis and subsequent treatment outcomes.
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