Diagnosing and treating mixed phenotype acute leukemia: a multicenter 10-year experience in México
- 653 Downloads
Mixed phenotype acute leukemia (MPAL) in adults represents nearly 2 to 5 % of all acute leukemia cases. There are two large studies throughout the world and only case reports and small series have been reported in Latin America. This study retrospectively analyses the clinical characteristics and survival of 27 patients with MPAL evaluated in three medical institutions of Mexico. All cases meet World Health Organization 2008 criteria; 70.3 % of patients had B lymphoid/myeloid lineage MPAL. Induction chemotherapy protocols included 7 + 3 hyper-CVAD, high-density schedules, and pediatric-like regimens such as New York II and total XI. Complete remission was achieved in 23/27 patients (85.2 %). Only one patient died due to chemotherapy-induced aplasia during remission induction (5.2 %). In 68 % of cases, we were able to administer maintenance therapy as a regimen in lymphoblastic leukemia. At the time of analysis, 70.4 % of the patients in the entire cohort had died mainly as result of disease progression (73.6 %). Disease-free survival was 13 months (95 % CI, 9.6–16.3 months) and overall survival was 14.8 months (95 % CI 13.4–16.27). Survival rates are low and standardized therapy for the management of this type of leukemia is still lacking. This is the largest series reported in Mexico and to the best of our knowledge in Latin America.
KeywordsMixed Phenotype Acute Leukemia MPAL EGIL WHO
The authors declare that they have no conflict of interest.
- 1.Matutes E, Pickl WF, Van’t Veer W, Morilla R, Swansbury J, Strobl H, Attarbaschi A, Hopfinger G, Ashley S, Bene MC, Porwit A, Orfao A, Lemez P, Schabath R, Ludwig WD (2011) Mixed-phenotype acute leukemia: clinical and laboratory features and outcome in 100 patients defined according to the WHO 2008 classification. Blood 117:3163–3171PubMedCrossRefGoogle Scholar
- 5.Jaffe ES, Harris NL, Stein H, Vardiman JW (2008) Pathology and genetics, tumor of hematopoietic and lymphoid tissues. IARC Press, Lyon, pp 150–155Google Scholar
- 6.Yan L, Ping N, Zhu M, Sun A, Xue Y, Ruan C, Drexler HG, MacLeod RAF, Wu D, Chen S (2012) Clinical, immunophenotypic, cytogenetic, and molecular genetic features in 117 adult patients with mixed-phenotype acute leukemia defined by WHO-2008 classification. Haematologica 97:1708–1712PubMedCentralPubMedCrossRefGoogle Scholar
- 8.Kantarjian H, Thomas D, O’Brien S, Cortes J, Giles F, Jeha S, Bueso-Ramos CE, Pierce S, Shan J, Koller C, Beran M, Keating M, Freireich EJ (2004) Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone (Hyper-CVAD) a dose-intensive regimen in adult acute lymphocytic leukemia. Cancer 101:2788–2801PubMedCrossRefGoogle Scholar
- 10.Arteaga L, Buitrón N, Rosas A, Rosas G, Armengolt-Jiménez A, Aguayo A, López X, Crespo-Solís E (2008) Experiencia del INCMNSZ en pacientes adultos con leucemia linfoide aguda, Cohorte 2003-2007 con esquemas de tratamiento Hiper-CVAD y Protocolo 0195. Rev Invest Cli 60:459–469Google Scholar
- 14.Bishop JF, Matthews JP, Young GA, Szer J, Gillett A, Joshua D, Bradstock K, Enno A, Wolf MM, Fox R, Cobcroft R, Herrmann R, Van Der Weyden M, Lowenthal RM, Page F, Garson OM, Juneja S (1996) A randomized study of high-dose cytarabine in induction in acute myeloid leukemia. Blood 87:1710–1717PubMedGoogle Scholar
- 15.Buitrón N, Arteaga L, Rosas-López A, Aguayo A, López-Karpovitch X, Crespo-Solís EL (2010) Experiencia del INCMNSZ en pacientes adultos con leucemia mieloide aguda. Cohorte 2003-2008. Rev Invest Cli 62:100–108Google Scholar
- 16.Estey E, Thall P, Andreeff M, Beran M, Kartarjian H, O´Brien S, Escudier S, Robertson LE, Koller C, Kornblau S (1994) Use of granulocyte colony stimulating factor before, during and after fludarabine plus cytarabine induction therapy of newly diagnosed acute myelogenous leukemia or myelodysplastic syndromes: comparison with fludarabine plus cytarabine without granulocyte colony-stimulating factor. J Clin Oncol 12:671–678PubMedGoogle Scholar
- 18.Grignaschi VJ, Pérez Bianco R, Aixalá M, de Tezanos Pinto M (1996) Review: concurrence of cytochemical and immune patterns of different cell lines in cases of acute leukemia. Medicina (B Aires) 56:339–345Google Scholar
- 19.Noronhal E, Trindade MarinhoI H, Abreu Fonseca EB, Assunção S, Ramos Veras GL, Gomes Oliveira R (2011) Immunophenotypic characterization of acute leukemia at a public oncology reference center in Maranhão, northeastern Brazil. Sao Paulo Med J 129:392–401Google Scholar
- 21.Deffis-Court M, Rosas-López A, López-Karpovitch X, Aguayo A, Crespo-Solís E. Leucemia Aguda Híbrida: Incidencia y descripción de pacientes del INCMNSZ.” AMEH LII Congress May 2011(abstract only)Google Scholar