Clinical Outcomes of Adult Patients With Newly Diagnosed Mixed Phenotype Acute Leukemia
Year: 2025
Type: article
Study design: Observational Study
Abstract: PURPOSE Mixed phenotype acute leukemia (MPAL) is a rare clinical entity with historically poor outcomes. METHODS We conducted a retrospective analysis of adults 18 years and older with newly diagnosed B-cell (B/M) or T-cell/myeloid (T/M) MPAL treated at our institution between 2017 and 2024. RESULTS We identified 42 patients (median age 70 years); 20 (48%) had B/M MPAL, and 22 (52%) had T/M MPAL; 57% of patients had adverse risk cytogenetics, and 41% had a TP53 mutation. Sixty-two percent of patients were treated with a hybrid regimen, and 45% of patients received intensive therapy. A composite complete remission (CRc; CR + CRi) was achieved in 57% of patients (86% measurable residual disease [MRD]–negative). After a median follow-up of 27.9 months, the median relapse-free survival in patients achieving an overall response (CRc + morphological leukemia-free state) was 10.1 months, 17.8 months in those who achieved a CRc, and not reached (NR) in patients with MRD-negative CRc. The median overall survival (OS) for all patients was 9.5 months and NR for patients achieving a CRc. Although patients with T/M MPAL had a trend toward improved survival compared with those with B/M MPAL (median OS of 9.1 v 25 months P = .28), this difference abrogated when comparison was stratified by treatment intensity. Twelve patients (29%) underwent allogeneic hematopoietic stem-cell transplantation (HSCT); on landmark analysis, HSCT trended to improve OS (NR v 22.8, P = .12). Multivariate Cox analysis demonstrated that TP53 mutation was associated with increased hazards for death (hazard ratio [HR], 3.5, P = .01), whereas the use of intensive chemotherapy trended to be favorable (HR, 0.45, P = .11). CONCLUSION Overall, these data demonstrate the need for treatment intensification in MPAL with HSCT in first remission for best outcomes.
Source: JCO Precision Oncology
DOI: 10.1200/po-25-00494
Authors: Hannah Goulart, Farhad Ravandi, Nicholas J. Short, Nitin Jain, Naval Daver, Tapan M. Kadia, Courtney DiNardo, Gautam Borthakur, Koichi Takahashi, Naveen Pemmaraju, Fadi G. Haddad, Guillermo Montalban Bravo, Yesid Alvarado, Ghayas C. Issa, Alex Bataller, Sherry Pierce, Sanam Loghavi, Guilin Tang, Sa A. Wang, Beenu Thakral, Elizabeth Shpall, Richard Champlin, Issa Khouri, Partow Kebriaei, Guillermo Garcia-Manero, Koji Sasaki, Elias J. Jabbour, Jayastu Senapati
Institution: The University of Texas MD Anderson Cancer Center
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4417209532