Mixed-phenotype acute leukemia: suboptimal treatment when the 2008/2016 WHO classification is used.
Mixed-phenotype acute leukemia: suboptimal treatment when the 2008/2016 WHO classification is used.
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DOI：
10.5045/br.2016.51.4.233
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发表时间：
2016-12
期刊：
影响因子：
2.2
通讯作者：
Aguayo-Gonzalez A
中科院分区：
文献类型：
--
作者：
Pomerantz A;Rodriguez-Rodriguez S;Demichelis-Gomez R;Barrera-Lumbreras G;Barrales-Benitez O;Lopez-Karpovitch X;Aguayo-Gonzalez A
不同的标准已被用于诊断混合表型急性白血病（MPAL），这影响了被诊断患有这种病理的个体数量。据报道，使用急性淋巴细胞白血病（ALL）型化疗治疗MPAL的结果更好。我们比较了4组MPAL患者的结局。第1组包括使用2008/2016世界卫生组织（WHO）分类诊断的患者;第2组包括使用欧洲白血病免疫学表征组（EGIL）标准诊断的患者;第3组包括使用EGIL或2008/2016 WHO标准诊断的患者;组4由仅使用EGIL分类诊断为MPAL的患者组成。我们发现，MPAL患者与其他急性白血病（AL）患者相比，无病生存期（第1 - 4组）和总生存期（OS）（第2组和第3组）显著更差。与急性髓性白血病（AML）型方案相比，接受ALL型化疗的患者（第2 - 4组）的OS显著更好。根据这些结果，并且由于与其他AL患者相比，发现第4组的OS有更好的趋势（P = 0.06），因此可以认为2008/2016 WHO分类诊断所有MPAL病例的效力不足，可能导致一些AL患者的治疗效果不佳。
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 (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.