Abstract
Mixed phenotype acute leukemia (MPAL) is a rare type of acute leukemia with a poor clinical outcome which lacks specific therapy. To evaluate the therapeutic efficiency of CCLG-2008 protocol used for acute lymphoblastic leukemia (ALL) in China on MPAL children who were initially diagnosed as ALL by morphology, we reviewed patients’ database diagnosed as ALL and MPAL according to WHO classification and compared their outcomes from July 2008 to June 2012. Total newly enrolled ALL in this study were 309 cases by morphology, in which ten cases were identified as MPAL mainly by immunophenotyping: B+ myeloid (3/10), T+ myeloid (2/10), B + T (4/10), trilineage (1/10). Two cases were classified as intermediate risk (IR) and 8 cases were high risk (HR) according to the CCLG-2008 criteria. Only one case of IR survived and others died due to primary resistance of chemotherapy and relapse. Compared with MPAL, ALL children in IR and HR had a longer survival (28.1 vs 9.5 months, p < 0.0001) and lower relapse (16.3 vs 85.7 %, p = 0.0002). In a summary, our result indicated that MPAL in children is a poor-risk disease which needs personalized therapy to improve outcome.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Rubio MT, Dhedin N, Boucheix C et al (2003) Adult T-biphenotypic acute leukaemia: clinical and biological features and outcome. Br J Haematol 123:842–849
Legrand O, Perrot JY, Simonin G et al (1998) Adult biphenotypic acute leukaemia: an entity with poor prognosis which is related to unfavourable cytogenetics and P-glycoprotein over-expression. Br J Haematol 100:147–155
Tiribelli M, Damiani D, Masolini P et al (2004) Biological and clinical features of T-biphenotypic acute leukaemia: report from a single centre. Br J Haematol 125:814–815
Killick S, Matutes E, Powles RL et al (1999) Outcome of biphenotypic acute leukemia. Haematologica 84:699–706
Aribi A, Bueso-Ramos C, Estey E et al (2007) Biphenotypic acute leukaemia: a case series. Br J Haematol 138:213–216
Borowitz M, Bene MC, Harris NL et al (2008) World Health Organization classification of tumours: pathology and genetics of tumours of haematopoietic and lymphoid tissues. IARC Press, Lyon, pp 150–155
Hu SY, Gu WY, Chen ZX et al (2010) The significance of detecting WT1 expressing in childhood acute leukemias. Pediatr Hematol Oncol 27:581–591
He J, Chen ZX, Xue YQ, et al (2005). Detection of fusion genes results from chromosome abnormalities in childhood acute lymphoblastic leukemia. Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 22:551–553
Gao C, Zhao XX, Li WJ et al (2012) Clinical features, early treatment responses, and outcomes of pediatric acute lymphoblastic leukemia in China with or without specific fusion transcripts: a single institutional study of 1,004 patients. Am J Hematol 87:1022–1027
Bailey LC, Lange BJ, Rheingold SR, Bunin NJ (2008) Bone-marrow relapses in paediatric acute lymphoblastic leukaemia. Lancet Oncol 9:873–883
Bene MC, Castoldi G, Knapp W et al (1995) Proposals for the immunological classification of acute leukemias: European group for the immunological characterization of leukemias (EGIL). Leukemia 9:1783–1786
Weir EG, Ansari-Lari M, Batista DA et al (1995) Acute bilineal leukemia: a rare disease with poor outcome. Leukemia 21:2264–2270
Rubnitz JE, Onciu M, Pounds S et al (2009) Acute mixed lineage leukemia in children: the experience of St Jude Children’s Research Hospital. Blood 113:5083–5089
Matutes E, Pickl WF, Van’t Veer M et al (2011) Mixed-phenotype acute leukemia: clinical and laboratory features and outcome in 100 patients defined according to the WHO 2008 classification. Blood 117:3163–3171
Acknowledgments
The authors would like to thank the grants of Jiangsu key clinical disease (No. BL2013014) and National Natural Science Foundation of China (No. 81100371, 81170513 and 81370627). The authors acknowledge Professor Cheng Cheng, St. Jude Children’s Research Hospital, Memphis, TN 38105, Professor Linda Stork, Pediatric Hematology/Oncology, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, Oregon 97239 and Professor Guang Fan, Clinical Flow Cytometry Laboratory, Department of Pathology, School of Medicine, Oregon Health and Science University, Portland, Oregon 97239 for their critical review of the manuscript.
Author information
Authors and Affiliations
Corresponding authors
Additional information
Jing Lu, Neetika Ashwani, and Mingying Zhang have contributed equally to this work.
Electronic supplementary material
Rights and permissions
About this article
Cite this article
Lu, J., Ashwani, N., Zhang, M. et al. Children Diagnosed as Mixed-Phenotype Acute Leukemia Didn’t Benefit from the CCLG-2008 Protocol, Retrospective Analysis from Single Center. Indian J Hematol Blood Transfus 31, 32–37 (2015). https://doi.org/10.1007/s12288-014-0372-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12288-014-0372-6