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KMID : 0366220160510040233
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Korean Journal of Hematology
2016 Volume.51 No. 4 p.233 ~ p.241
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Mixed-phenotype acute leukemia: suboptimal treatment when the 2008/2016 WHO classification is used
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Alan Pomerantz
Sergio Rodriguez-Rodriguez
Roberta Demichelis-Gomez
Georgina Barrera-Lumbreras
Olga Barrales-Benitez
Xavier Lopez-Karpovitch
Alvaro Aguayo-Gonzalez
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Abstract
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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.
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KEYWORD
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Mixed-phenotype acute leukemia, WHO classification, EGIL classification, Suboptimal treatment
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