Pomerantz Alan, Rodriguez-Rodriguez Sergio, Demichelis-Gomez Roberta, Barrera-Lumbreras Georgina, Barrales-Benitez Olga, Lopez-Karpovitch Xavier, Aguayo-Gonzalez Alvaro
Department 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.
Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico.
Blood Res. 2016 Dec;51(4):233-241. doi: 10.5045/br.2016.51.4.233. Epub 2016 Dec 23.
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.
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.
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.
In light of these results, and because a trend (=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.
不同的标准已被用于诊断混合表型急性白血病（MPAL），这影响了被诊断为此种病理类型的个体数量。据报道，在MPAL治疗中使用急性淋巴细胞白血病（ALL）型化疗可取得更好的疗效。
我们比较了4组MPAL患者的治疗结果。第1组包括使用2008/2016年世界卫生组织（WHO）分类法诊断的患者；第2组包括使用欧洲白血病免疫特征研究组（EGIL）标准诊断的患者；第3组包括使用EGIL或2008/2016年WHO标准诊断的患者；第4组由仅使用EGIL分类法诊断为MPAL的患者组成。
我们发现，与其他急性白血病（AL）患者相比，MPAL患者的无病生存率（第1 - 4组）和总生存率（OS）（第2组和第3组）明显更差。与急性髓系白血病（AML）型方案相比，接受ALL型化疗的患者（第2 - 4组）的OS明显更好。
鉴于这些结果，并且由于与其他AL患者相比，第4组在OS方面发现有更好的趋势（=0.06），可以认为2008/2016年WHO分类法在诊断所有MPAL病例方面能力不足，可能导致一些AL患者治疗效果欠佳。
