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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and 8193=(select (case when (8193=1440) then 8193 else (select 1440 union select 7618) end))-- wyue] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 order by 1-- ciuf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (8983=5378) then null else cast((chr(100)||chr(108)||chr(65)||chr(65)) as numeric) end)) is null] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 rlike (select (case when (2220=2220) then 0x31302e313030322f6379746f2e622e3231373833 else 0x28 end))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 order by 1#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (8951=8951) then null else cast((chr(80)||chr(107)||chr(78)||chr(65)) as numeric) end)) is null] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 or extractvalue(1224,concat(0x5c,0x7170707871,(select (elt(1224=1224,1))),0x7162627671))-- eljp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and 5328=5155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (8951=8951) then null else cast((chr(80)||chr(107)||chr(78)||chr(65)) as numeric) end)) is null-- fcav] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 or (select 3518 from(select count(*),concat(0x7170707871,(select (elt(3518=3518,1))),0x7162627671,floor(rand(0)*2))x from information_schema.plugins group by x)a)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (1060=9577) then null else ctxsys.drithsx.sn(1,1060) end) from dual) is null-- tpsl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select 4939 from(select count(*),concat(0x7170707871,(select (elt(4939=4939,1))),0x7162627671,floor(rand(0)*2))x from information_schema.plugins group by x)a)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 96:183-194. [DOI: 10.1002/cyto.b.21783] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (7918=8049) then null else cast((chr(86)||chr(82)||chr(121)||chr(120)) as numeric) end)) is null-- tdsx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and (select (case when (4013=1059) then null else ctxsys.drithsx.sn(1,4013) end) from dual) is null] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and 4849=4849-- dmuz] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and 4685=(select (case when (4685=4685) then 4685 else (select 8730 union select 8797) end))-- hylr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Porwit A, Béné MC. Multiparameter flow cytometry applications in the diagnosis of mixed phenotype acute leukemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019. [DOI: 10.1002/cyto.b.21783 and 4849=4849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences Lund, Oncology and Pathology, Faculty of MedicineLund University Lund Sweden
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Psaila B, Mead AJ. Single-cell approaches reveal novel cellular pathways for megakaryocyte and erythroid differentiation. Blood 2019; 133:1427-1435. [PMID: 30728145 PMCID: PMC6443046 DOI: 10.1182/blood-2018-11-835371] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/07/2019] [Indexed: 12/18/2022] Open
Abstract
The classical model of hematopoiesis proposes a hierarchy in which a small number of multipotent hematopoietic stem cells (HSCs) maintain all blood lineages by giving rise to progeny that pass through discrete progenitor stages. At each stage, lineage differentiation potential is restricted, coupled with the loss of ability to self-renew. Recently, single-cell approaches have been used to test certain assumptions made by this model, in particular relating to megakaryocyte (Mk) and erythroid (E) development. An alternative model has emerged in which substantial heterogeneity and lineage-priming exists within the HSC compartment, including the existence of multipotent but megakaryocyte/platelet-biased HSCs. Hematopoietic differentiation follows a hierarchical continuum, passing through cellular nodes and branch points. Megakaryocytes are produced via a shared pathway with the erythroid lineage, also shared in its early stages with mast cells, eosinophils, and basophils, but separate from other myeloid and lymphoid lineages. In addition, distinct pathways for direct differentiation of Mk from HSCs may coexist and could be important in situations of increased physiological requirements or in malignancies. Further work at single-cell resolution using multiomic approaches and examining Mk-E biased subsets within their physiological context will undoubtedly improve our understanding of normal hematopoiesis and ability to manipulate this in pathology.
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Affiliation(s)
- Bethan Psaila
- Haematopoietic Stem Cell Biology Laboratory, MRC Weatherall Institute of Molecular Medicine (WIMM). University of Oxford, Oxford, OX3 9DS, UK
- Medical Research Council Molecular Haematology Unit, WIMM, University of Oxford, Oxford, OX3 9DS, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Adam J Mead
- Haematopoietic Stem Cell Biology Laboratory, MRC Weatherall Institute of Molecular Medicine (WIMM). University of Oxford, Oxford, OX3 9DS, UK
- Medical Research Council Molecular Haematology Unit, WIMM, University of Oxford, Oxford, OX3 9DS, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
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Lee HG, Baek HJ, Kim HS, Park SM, Hwang TJ, Kook H. Biphenotypic acute leukemia or acute leukemia of ambiguous lineage in childhood: clinical characteristics and outcome. Blood Res 2019; 54:63-73. [PMID: 30956966 PMCID: PMC6439300 DOI: 10.5045/br.2019.54.1.63] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/08/2018] [Accepted: 11/13/2018] [Indexed: 01/05/2023] Open
Abstract
Background Acute leukemia (AL), not clearly assigned to myeloid, B-lymphoid, or T-lymphoid lineage, is classified as either biphenotypic acute leukemia (BAL) based on the European Group for Immunological Classification of Leukemias (EGIL) or acute leukemia of ambiguous lineage (ALAL) encompassing acute undifferentiated leukemia (AUL) and mixed-phenotype acute leukemia (MPAL) based on the World Health Organization (WHO) criteria. Methods Medical records of children newly diagnosed with BAL or ALAL, based on the EGIL or the 2008/2016 WHO criteria, respectively, admitted at Chonnam National University Hospital in 2001-2017 were retrospectively reviewed. Results Twelve (3.2%) of 377 AL patients satisfied the BAL or ALAL definitions based on the EGIL or the WHO criteria, respectively. Among 12 patients including 11 with BAL and another with undefined case based on the EGIL criteria, 7 (1.9%) had ALAL based on more stringent 2016 WHO criteria (AUL, 2; MPAL, 5). One patient had MPAL with t(9;22)(q34;q11.2), BCR-ABL+, and two had MLL gene abnormality. ALL-directed regimen was associated with better complete remission rate compared with AML-directed regimen (100.0% vs. 16.7%; P=0.015). The 5-year overall survival (OS) and event-free survival (EFS) were 51.1±15.8% and 51.9±15.7%, respectively. AUL was associated with poor OS and EFS compared with MPAL (0.0% vs. 75.0±21.7%; P=0.008). Conclusion Due to the rarity of the cases, future multicenter, prospective studies incorporating large number of cases are urgently warranted to identify the clinical, biologic, and molecular markers for the prediction of prognosis and determine the best tailored therapy for each patient.
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Affiliation(s)
- Hyun Gyung Lee
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.,Environmental Health Center for Childhood Leukemia and Cancer, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ho Sung Kim
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Min Park
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Tai Ju Hwang
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Hoon Kook
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.,Environmental Health Center for Childhood Leukemia and Cancer, Chonnam National University Hwasun Hospital, Hwasun, Korea
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Awasthi NP, Singh P, Agrawal N. Mixed Phenotype Acute Leukemia, B/Myeloid with t(9;22): Diagnostic and Therapeutic Challenges. Indian J Hematol Blood Transfus 2019; 35:179-181. [PMID: 30828170 DOI: 10.1007/s12288-018-1020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Namrata P Awasthi
- 1Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Poonam Singh
- 2Department of Lab Medicine, Sahara Hospital, Viraj Khand, Gomti Nagar, Lucknow, 226010 India
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Gupta N, Pawar R, Banerjee S, Brahma S, Rath A, Shewale S, Parihar M, Singh M, Arun SR, Krishnan S, Bhatacharyya A, Das A, Kumar J, Bhave S, Radhakrishnan V, Nair R, Chandy M, Arora N, Mishra D. Spectrum and Immunophenotypic Profile of Acute Leukemia: A Tertiary Center Flow Cytometry Experience. Mediterr J Hematol Infect Dis 2019; 11:e2019017. [PMID: 30858955 PMCID: PMC6402547 DOI: 10.4084/mjhid.2019.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/19/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND For diagnosis, sub-categorization and follow up of Acute Leukemia (AL), phenotypic analysis using flow cytometry is mandatory. MATERIAL AND METHODS We retrospectively analyzed immunophenotypic data along with cytogenetics/molecular genetics data (wherever available) from 631 consecutive cases of AL diagnosed at our flow cytometry laboratory from January 2014 to August 2017. RESULTS Of the total 631 cases, 52.9% (n=334) were acute lymphoblastic leukemia (ALL), 43.9% (n=277) acute myeloid leukemia (AML), 2.2% (n=14) mixed phenotypic acute leukemia (MPAL), 0.5% (n=3) acute undifferentiated leukemia (AUL) and 0.5% (n=3) chronic myeloid leukemia in blast crisis (CML-BC). ALL cases comprised of 81.7% (n=273/334) B-cell ALLs (95.2%, n=260/273 common B-ALLs and 4.8%, n=13/273 Pro B-ALLs). CD13 was the commonest cross lineage antigen, expressed in B-ALL (25.6%, n=70/273), followed by CD33 (17.9%, n=49) and combined CD13/CD33 (11.3%, n=31/273) expression. T-ALLs constituted 18.3% (n=61/334) of total ALLs and included 27.9% (n=17/61) cortical T- ALLs. CD13 was commonest (32.7%, n=20/61) aberrantly expressed antigen in T-ALLs, followed by CD117 (19.1%, n=9/47). AML cases included 32.1% (n=89/277) AML with recurrent genetic abnormalities, 9.0% (n=25/277) with FLT3/NPM1c mutation and 58.9% (n=163/277) AML NOS including 14.7% (n=24/163) AML M4/M5, 1.8% (n=3/163) AML M6 and 3.7% (n=6/163) AML M7. In AMLs, CD19 aberrancy was the most common (20.2%, n=56/277) followed by CD56 (15.8%, n=42/265). CONCLUSIONS In this study, we document the spectrum, correlate the immunophenotype with genetic data of all leukemias, especially concerning T-ALL where the data from India is scarce.
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Affiliation(s)
- Nishit Gupta
- Department of Laboratory Hematology, Tata Medical Center, Kolkata
| | - Ravikiran Pawar
- Department of Laboratory Hematology, Tata Medical Center, Kolkata
| | | | - Subhajit Brahma
- Department of Laboratory Hematology, Tata Medical Center, Kolkata
| | - Asish Rath
- Department of Laboratory Hematology, Tata Medical Center, Kolkata
| | - Sundar Shewale
- Department of Laboratory Hematology, Tata Medical Center, Kolkata
| | - Mayur Parihar
- Department of Laboratory Hematology and Cytogenetics, Tata Medical Center, Kolkata
| | - Manish Singh
- Department of Laboratory Hematology and Cytogenetics, Tata Medical Center, Kolkata
| | - S R Arun
- Department of Laboratory Hematology and Cytogenetics, Tata Medical Center, Kolkata
| | | | | | - Anirban Das
- Department of Pediatric Oncology, Tata Medical Center, Kolkata
| | - Jeevan Kumar
- Department of Clinical Hematology, Tata Medical Center, Kolkata
| | - Saurabh Bhave
- Department of Clinical Hematology, Tata Medical Center, Kolkata
| | | | - Reena Nair
- Department of Clinical Hematology, Tata Medical Center, Kolkata
| | - Mammen Chandy
- Department of Clinical Hematology, Tata Medical Center, Kolkata
| | - Neeraj Arora
- Department of Laboratory Hematology and Molecular Genetics, Tata Medical Center, Kolkata
| | - Deepak Mishra
- Department of Laboratory Hematology and Molecular Genetics, Tata Medical Center, Kolkata
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Martin-Guerrero I, Salaverria I, Burkhardt B, Chassagne-Clement C, Szczepanowski M, Bens S, Klapper W, Zimmermann M, Kabickova E, Bertrand Y, Reiter A, Siebert R, Oschlies I. Non-leukemic pediatric mixed phenotype acute leukemia/lymphoma: Genomic characterization and clinical outcome in a prospective trial for pediatric lymphoblastic lymphoma. Genes Chromosomes Cancer 2018; 58:365-372. [PMID: 30578714 DOI: 10.1002/gcc.22726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 11/08/2022] Open
Abstract
Rare cases of hematological precursor neoplasms fulfill the diagnostic criteria of mixed phenotype acute leukemia (MPAL), characterized by expression patterns of at least two hematopoietic lineages, for which a highly aggressive behavior was reported. We present a series of 11 pediatric non-leukemic MPAL identified among 146 precursor lymphoblastic lymphomas included in the prospective trial Euro-LBL 02. Paraffin-embedded biopsies of 10 cases were suitable for molecular analyses using OncoScan assay (n = 7), fluorescence in situ hybridization (FISH; n = 7) or both (n = 5). Except for one case with biallelic KMT2A (MLL) breaks, all cases analyzed by FISH lacked the most common translocations defining molecular subsets of lymphoblastic leukemia/lymphomas. Two non-leukemic B-myeloid MPALs showed the typical genomic profile of hyperdiploid precursor B-cell lymphoblastic leukemia with gains of chromosomes 4, 6, 10, 14, 18, and 21. One B-T MPAL showed typical aberrations of T-cell lymphoblastic lymphoma, such as copy number neutral loss of heterozygosity (CNN-LOH) at 9p targeting a 9p21.3 deletion of CDKN2A and 11q12.2-qter affecting the ATM gene. ATM was also mutated in a T-myeloid MPAL case with additional loss at 7q21.2-q36.3 and mutation of NRAS, two alterations common in myeloid disorders. No recurrent regions of CNN-LOH were observed. The outcome under treatment was good with all patients being alive in first complete remission after treatment according to a protocol for precursor lymphoblastic lymphoma (follow-up 3-10 years, median: 4.9 years). In summary, the present series of non-leukemic MPALs widely lacked recurrently reported translocations in lymphoid/myeloid neoplasias and showed heterogeneous spectrum of chromosomal imbalances.
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Affiliation(s)
- Idoia Martin-Guerrero
- Institute of Human Genetics, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrechts University, Kiel, Germany.,Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country, Leioa, Spain
| | - Itziar Salaverria
- Institute of Human Genetics, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrechts University, Kiel, Germany.,Department of Pathology, Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERONC, University of Barcelona, Barcelona, Spain
| | - Birgit Burkhardt
- NHL-BFM Study Center and Department of Pediatric Hematology and Oncology, University Children's Hospital, Münster, Germany
| | | | - Monika Szczepanowski
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrechts University, Kiel, Germany
| | - Susanne Bens
- Institute of Human Genetics, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrechts University, Kiel, Germany.,Institute of Human Genetics, Ulm University & Ulm University Medical Center, Ulm, Germany
| | - Wolfram Klapper
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrechts University, Kiel, Germany
| | - Martin Zimmermann
- Department of Pediatric Hematology and Oncology, Medical School Hannover, Hannover, Germany
| | - Edita Kabickova
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University Prague and University Hospital Motol, Motol, Czech Republic
| | - Yves Bertrand
- Department of Pediatric Hematology, IHOP and Claude Bernard University, Lyon, France
| | - Alfred Reiter
- Department of Pediatric Hematology and Oncology, NHL-BFM-Study Center Justus Liebig University, Germany
| | - Reiner Siebert
- Institute of Human Genetics, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrechts University, Kiel, Germany.,Institute of Human Genetics, Ulm University & Ulm University Medical Center, Ulm, Germany
| | - Ilske Oschlies
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrechts University, Kiel, Germany
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134
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Lao ZT, Ding LW, An O, Hattori N, Sun QY, Tan KT, Mayakonda A, Chuan WG, Madan V, Lin DC, Yang H, Koeffler HP. Mutational and transcriptomic profiling of acute leukemia of ambiguous lineage reveals obscure but clinically important lineage bias. Haematologica 2018; 104:e200-e203. [PMID: 30514800 DOI: 10.3324/haematol.2018.202911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Zhen-Tang Lao
- Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Haematology, Singapore General Hospital, Singapore
| | - Ling-Wen Ding
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Omer An
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Norimichi Hattori
- Division of Hematology, Department of Medicine, Showa University, Tokyo, Japan
| | - Qiao-Yang Sun
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Kar-Tong Tan
- Division of Medical Sciences, Harvard Medical School, Boston, MA. USA
| | - Anand Mayakonda
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Wong Gee Chuan
- Department of Haematology, Singapore General Hospital, Singapore
| | - Vikas Madan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - De-Chen Lin
- Division of Hematology/Oncology, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA, USA
| | - Henry Yang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - H Phillip Koeffler
- Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Division of Hematology/Oncology, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA, USA
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135
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Mi X, Griffin G, Lee W, Patel S, Ohgami R, Ok CY, Wang S, Geyer JT, Xiao W, Roshal M, Garcia JS, Silverman LB, Sallan SE, Aster JC, Harris MH, Weinberg OK. Genomic and clinical characterization of B/T mixed phenotype acute leukemia reveals recurrent features and T-ALL like mutations. Am J Hematol 2018; 93:1358-1367. [PMID: 30117174 DOI: 10.1002/ajh.25256] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 01/29/2023]
Abstract
The B/T subtype of mixed phenotype acute leukemia (B/T MPAL) is defined by co-expression of antigens of both B- and T-cell lineages on leukemic blasts. Although it has been suggested that multilineage antigen expression portends poor response to chemotherapy, the clinical characteristics and driver mutations that underlie the pathogenesis of this rare subtype of acute leukemia are scarcely known. We identified nine cases of B/T MPAL from multiple institutions and correlated clinical and immunophenotypic findings with next-generation sequencing data. We report that B/T MPAL commonly presents with lymphadenopathy in adolescence and young adulthood. While the tumors have diverse cytogenetic and genomic perturbations, recurrent acquired aberrations include mutations in the putative transcriptional regulator PHF6 and the JAK-STAT and Ras signaling pathways. Alterations were also identified in genes encoding hematopoietic transcription factors, cell cycle regulators/tumor suppressors, and chromatin modifying enzymes. The genomic landscape of B/T MPAL strongly resembles that of T-ALL subgroups associated with early developmental arrest, while genetic alterations that are common in B-ALL were rarely seen. Two-thirds of the patients responded to ALL-based chemotherapy with or without stem cell transplantation. Our observations lay the groundwork for further study of the unique biology and clinical trajectory of B/T MPAL.
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Affiliation(s)
- Xiaoli Mi
- Harvard-MIT Division of Health Sciences and Technology; Harvard Medical School; Boston Massachusetts
- Department of Pathology; Boston Children's Hospital; Boston Massachusetts
| | - Gabriel Griffin
- Department of Pathology; Brigham and Women's Hospital; Boston Massachusetts
| | - Winston Lee
- Department of Pathology; Brigham and Women's Hospital; Boston Massachusetts
| | - Sanjay Patel
- Department of Pathology; Brigham and Women's Hospital; Boston Massachusetts
| | - Robert Ohgami
- Department of Pathology; Stanford University Medical Center; California
| | - Chi Young Ok
- Department of Hematopathology, Division of Pathology and Laboratory Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Sa Wang
- Department of Hematopathology, Division of Pathology and Laboratory Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Julia T. Geyer
- Division of Hematopathology; New York-Presbyterian/Weill Cornell Medical College; New York New York
| | - Wenbin Xiao
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center; New York New York
| | - Mikhail Roshal
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center; New York New York
| | | | - Lewis B. Silverman
- Department of Pediatric Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
- Division of Pediatric Hematology-Oncology; Boston Children's Hospital; Boston Massachusetts
| | - Stephen E. Sallan
- Department of Pediatric Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
- Division of Pediatric Hematology-Oncology; Boston Children's Hospital; Boston Massachusetts
| | - Jon C. Aster
- Department of Pathology; Brigham and Women's Hospital; Boston Massachusetts
| | - Marian H. Harris
- Department of Pathology; Boston Children's Hospital; Boston Massachusetts
| | - Olga K. Weinberg
- Department of Pathology; Boston Children's Hospital; Boston Massachusetts
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136
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Huh SJ, Kim SH, Kim HJ, Han JY, Lim H, Lee JH. Philadelphia-positive mixed phenotype acute leukemia presenting with PML-RARα fusion transcript without t(15;17) on cytogenetic studies. Blood Res 2018; 53:256-260. [PMID: 30310796 PMCID: PMC6170305 DOI: 10.5045/br.2018.53.3.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/19/2018] [Accepted: 05/23/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Seok Jae Huh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Sung-Hyun Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Hyo-Jin Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jin Yeong Han
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Hyeonho Lim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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137
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Alexander TB, Gu Z, Iacobucci I, Dickerson K, Choi JK, Xu B, Payne-Turner D, Yoshihara H, Loh ML, Horan J, Buldini B, Basso G, Elitzur S, de Haas V, Zwaan CM, Yeoh A, Reinhardt D, Tomizawa D, Kiyokawa N, Lammens T, De Moerloose B, Catchpoole D, Hori H, Moorman A, Moore AS, Hrusak O, Meshinchi S, Orgel E, Devidas M, Borowitz M, Wood B, Heerema NA, Carrol A, Yang YL, Smith MA, Davidsen TM, Hermida LC, Gesuwan P, Marra MA, Ma Y, Mungall AJ, Moore RA, Jones SJM, Valentine M, Janke LJ, Rubnitz JE, Pui CH, Ding L, Liu Y, Zhang J, Nichols KE, Downing JR, Cao X, Shi L, Pounds S, Newman S, Pei D, Guidry Auvil JM, Gerhard DS, Hunger SP, Inaba H, Mullighan CG. The genetic basis and cell of origin of mixed phenotype acute leukaemia. Nature 2018; 562:373-379. [PMID: 30209392 PMCID: PMC6195459 DOI: 10.1038/s41586-018-0436-0] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 07/03/2018] [Indexed: 12/16/2022]
Abstract
Mixed phenotype acute leukaemia (MPAL) is a high-risk subtype of leukaemia with myeloid and lymphoid features, limited genetic characterization, and a lack of consensus regarding appropriate therapy. Here we show that the two principal subtypes of MPAL, T/myeloid (T/M) and B/myeloid (B/M), are genetically distinct. Rearrangement of ZNF384 is common in B/M MPAL, and biallelic WT1 alterations are common in T/M MPAL, which shares genomic features with early T-cell precursor acute lymphoblastic leukaemia. We show that the intratumoral immunophenotypic heterogeneity characteristic of MPAL is independent of somatic genetic variation, that founding lesions arise in primitive haematopoietic progenitors, and that individual phenotypic subpopulations can reconstitute the immunophenotypic diversity in vivo. These findings indicate that the cell of origin and founding lesions, rather than an accumulation of distinct genomic alterations, prime tumour cells for lineage promiscuity. Moreover, these findings position MPAL in the spectrum of immature leukaemias and provide a genetically informed framework for future clinical trials of potential treatments for MPAL.
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Affiliation(s)
- Thomas B Alexander
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Zhaohui Gu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ilaria Iacobucci
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten Dickerson
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - John K Choi
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Beisi Xu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Debbie Payne-Turner
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hiroki Yoshihara
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mignon L Loh
- Department of Pediatrics, Benioff Children's Hospital and the Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, USA
| | - John Horan
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
| | - Barbara Buldini
- Department of Women and Child Health, Hemato-Oncology Division, University of Padova, Padova, Italy
| | - Giuseppe Basso
- Department of Women and Child Health, Hemato-Oncology Division, University of Padova, Padova, Italy
| | - Sarah Elitzur
- Pediatric Hematology-Oncology, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - C Michel Zwaan
- Prinses Maxima Centre, Utrecht, The Netherlands
- Department of Pediatric Oncology, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Allen Yeoh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Daisuke Tomizawa
- Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Nobutaka Kiyokawa
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Tim Lammens
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Daniel Catchpoole
- The Tumour Bank CCRU, The Kids Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Hiroki Hori
- Department of Pediatrics, Mie University, Tsu, Japan
| | - Anthony Moorman
- Wolfson Childhood Cancer Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - Andrew S Moore
- The University of Queensland Diamantina Institute & Children's Health, Brisbane, Queensland, Australia
| | - Ondrej Hrusak
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Soheil Meshinchi
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA
- Children's Oncology Group, Arcadia, CA, USA
| | - Etan Orgel
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Brent Wood
- University of Washington, Seattle, WA, USA
| | - Nyla A Heerema
- The Ohio State University School of Medicine, Columbus, OH, USA
| | - Andrew Carrol
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yung-Li Yang
- Department of Laboratory Medicine and Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
| | - Tanja M Davidsen
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Rockville, MD, USA
| | - Leandro C Hermida
- Office of Cancer Genomics, National Cancer Institute, Bethesda, MD, USA
| | - Patee Gesuwan
- Office of Cancer Genomics, National Cancer Institute, Bethesda, MD, USA
| | - Marco A Marra
- Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Yussanne Ma
- Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Andrew J Mungall
- Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Richard A Moore
- Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Steven J M Jones
- Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Marcus Valentine
- Cytogenetics Shared Resource, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Laura J Janke
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeffrey E Rubnitz
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Liang Ding
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yu Liu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kim E Nichols
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - James R Downing
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Xueyuan Cao
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lei Shi
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Stanley Pounds
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Scott Newman
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deqing Pei
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Daniela S Gerhard
- Office of Cancer Genomics, National Cancer Institute, Bethesda, MD, USA
| | - Stephen P Hunger
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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138
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Biphenotypic Acute Leukemia versus Myeloid Antigen-Positive ALL: Clinical Relevance of WHO Criteria for Mixed Phenotype Acute Leukemia. Case Rep Hematol 2018; 2018:7456378. [PMID: 30140473 PMCID: PMC6081595 DOI: 10.1155/2018/7456378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022] Open
Abstract
Updated WHO criteria define mixed phenotype acute leukemia (MPAL) with more stringent diagnostic criteria than the formerly described entity biphenotypic acute leukemia (BAL). The changes in diagnostic criteria influence management by assigning weight to aberrantly expressed markers and minimizing expression of myeloid markers other than myeloperoxidase (MPO), potentially foregoing consolidative allogeneic transplant for an otherwise "favorable" lymphoid phenotypic leukemia. We present a case of MPO-negative, myeloid antigen-positive acute lymphoblastic leukemia who progressed with refractory phenotypic acute myeloid leukemia while receiving lymphoid-directed therapy and discuss concerns raised by the adoption of the new, more stringent diagnostic criteria for BAL.
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139
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Singh ZN, Duong VH, Koka R, Zou Y, Sawhney S, Tang L, Baer MR, Ambulos N, El Chaer F, Emadi A. High-Risk Acute Promyelocytic Leukemia with Unusual T/Myeloid Immunophenotype Successfully Treated with ATRA and Arsenic Trioxide-Based Regimen. J Hematop 2018; 11:67-74. [PMID: 30294391 DOI: 10.1007/s12308-018-0329-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We describe two patients with acute promyelocytic leukemia (APL) with an unusual immunophenotype with co-expression of myeloperoxidase (MPO) with cytoplasmic CD3 (cCD3) representing myeloid and T-lineage differentiation. Both harbored FLT3-ITD mutations. One additionally had a deletion in the PML gene affecting the primer binding site, thus limiting measurable residual disease (MRD) analysis during follow-up. Both patients achieved durable remission with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO)-based therapy, thus mitigating the need for repetitive conventional chemotherapy cycles and allogeneic stem cell transplantation. Our report highlights the complexity and challenge of diagnosis and management of APL due to the variant immunophenotype and genetics, and underscores the importance of synthesizing information from all testing modalities. The association of the unusual immunophenotype and FLT3-ITD mutation illustrates the plasticity of the hematopoietic stem cell and the pathobiology of leukemia with mixed lineage or lineage infidelity.
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Affiliation(s)
- Zeba N Singh
- Department of Pathology, University of Maryland School of Medicine
| | - Vu H Duong
- Department of Medicine, University of Maryland School of Medicine.,University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
| | - Rima Koka
- Department of Pathology, University of Maryland School of Medicine
| | - Ying Zou
- Department of Pathology, University of Maryland School of Medicine
| | - Sameer Sawhney
- Department of Pathology, University of Maryland School of Medicine
| | - Li Tang
- University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
| | - Maria R Baer
- Department of Medicine, University of Maryland School of Medicine.,University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
| | - Nicholas Ambulos
- University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
| | - Firas El Chaer
- Department of Medicine, University of Maryland School of Medicine.,University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
| | - Ashkan Emadi
- Department of Medicine, University of Maryland School of Medicine.,Department of Pharmacology, University of Maryland School of Medicine.,University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, MD, USA
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140
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Mixed-phenotype acute leukemia characteristics: first report from Iran. Clin Exp Med 2018; 18:513-521. [DOI: 10.1007/s10238-018-0520-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022]
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141
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Integrative genomic analysis of adult mixed phenotype acute leukemia delineates lineage associated molecular subtypes. Nat Commun 2018; 9:2670. [PMID: 29991687 PMCID: PMC6039465 DOI: 10.1038/s41467-018-04924-z] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/31/2018] [Indexed: 11/25/2022] Open
Abstract
Mixed phenotype acute leukemia (MPAL) is a rare subtype of acute leukemia characterized by leukemic blasts presenting myeloid and lymphoid markers. Here we report data from integrated genomic analysis on 31 MPAL samples and compare molecular profiling with that from acute myeloid leukemia (AML), B cell acute lymphoblastic leukemia (B-ALL), and T cell acute lymphoblastic leukemia (T-ALL). Consistent with the mixed immunophenotype, both AML-type and ALL-type mutations are detected in MPAL. Myeloid-B and myeloid-T MPAL show distinct mutation and methylation signatures that are associated with differences in lineage-commitment gene expressions. Genome-wide methylation comparison among MPAL, AML, B-ALL, and T-ALL sub-classifies MPAL into AML-type and ALL-type MPAL, which is associated with better clinical response when lineage-matched therapy is given. These results elucidate the genetic and epigenetic heterogeneity of MPAL and its genetic distinction from AML, B-ALL, and T-ALL and further provide proof of concept for a molecularly guided precision therapy approach in MPAL. Mixed phenotype acute leukemia (MPAL) is a rare leukemia that presents both myeloid and lymphoid markers on blasts. Here the authors perform genomic analysis to show MPAL involves genetic and epigenetic heterogeneity and is genetically distinct from AML, B-ALL, and T-ALL.
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142
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Rossi JG, Rubio P, Alonso CN, Bernasconi AR, Sajaroff EO, Digiorge J, Baialardo E, Eandi-Eberle S, Guitter M, Fernandez-Barbieri A, Mitchell R, Felice MS. Cytoplasmic CD3 expression in infant acute megakaryoblastic leukemia: A new ambiguous lineage subtype? Leuk Res 2018; 71:6-12. [PMID: 29935384 DOI: 10.1016/j.leukres.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/14/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Abstract
Several conventions have been established in order to define and characterize Mixed Phenotype Acute Leukemia (MPAL). However, megakaryocytic markers have not been included in the definition of MPAL neither in the European Group for the Immunological Characterization of Leukemias (EGIL) proposal nor in any of the WHO Classification of Tumors issues. We report four pediatric acute leukemia (AL) cases (prevalence: 0.18%) with megakaryoblasts co-expressing the T-specific antigen CD3 (cytoplasmic), together with a very homogeneous antigen profile of immature cells and other lymphoid traits. In one case, the presence of epsilon CD3 mRNA was confirmed as well on sorted CD34+ blasts. All four cases were infants, and two of them disclosed trisomy 21 in the blast population (not constitutional) without being children with Down Syndrome. They were homogeneously treated with AML schemes, achieving all four CR. However, 3 patients relapsed early. Only one patient is alive and remain disease-free, with a long follow-up. Even though cyCD3 was the only T cell marker expressed, its specificity entails the consideration of these cases as a new subtype of MPAL Megakaryoblastic/T, keeping this in mind when designing diagnostic panels. Detection and report of these cases are necessary so as to further characterize them in order to define the most appropriate treatment.
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Affiliation(s)
- Jorge Gabriel Rossi
- Hospital de Pediatria prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina.
| | - Patricia Rubio
- Hospital de Pediatria prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Cristina N Alonso
- Hospital de Pediatria prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Andrea R Bernasconi
- Hospital de Pediatria prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Elisa O Sajaroff
- Hospital de Pediatria prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Jorge Digiorge
- Hospital de Pediatria prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Edgardo Baialardo
- Hospital de Pediatria prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Silvia Eandi-Eberle
- Hospital de Pediatria prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Myriam Guitter
- Hospital de Pediatria prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | | | - Raquel Mitchell
- Hospital de Pediatria prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Maria Sara Felice
- Hospital de Pediatria prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
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143
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International cooperative study identifies treatment strategy in childhood ambiguous lineage leukemia. Blood 2018; 132:264-276. [PMID: 29720486 DOI: 10.1182/blood-2017-12-821363] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/09/2018] [Indexed: 01/15/2023] Open
Abstract
Despite attempts to improve the definitions of ambiguous lineage leukemia (ALAL) during the last 2 decades, general therapy recommendations are missing. Herein, we report a large cohort of children with ALAL and propose a treatment strategy. A retrospective multinational study (International Berlin-Frankfurt-Münster Study of Leukemias of Ambiguous Lineage [iBFM-AMBI2012]) of 233 cases of pediatric ALAL patients is presented. Survival statistics were used to compare the prognosis of subsets and types of treatment. Five-year event-free survival (EFS) of patients with acute lymphoblastic leukemia (ALL)-type primary therapy (80% ± 4%) was superior to that of children who received acute myeloid leukemia (AML)-type or combined-type treatment (36% ± 7.2% and 50% ± 12%, respectively). When ALL- or AML-specific gene fusions were excluded, 5-year EFS of CD19+ leukemia was 83% ± 5.3% on ALL-type primary treatment compared with 0% ± 0% and 28% ± 14% on AML-type and combined-type primary treatment, respectively. Superiority of ALL-type treatment was documented in single-population mixed phenotype ALAL (using World Health Organization and/or European Group for Immunophenotyping of Leukemia definitions) and bilineal ALAL. Treatment with ALL-type protocols is recommended for the majority of pediatric patients with ALAL, including cases with CD19+ ALAL. AML-type treatment is preferred in a minority of ALAL cases with CD19- and no other lymphoid features. No overall benefit of transplantation was documented, and it could be introduced in some patients with a poor response to treatment. As no clear indicator was found for a change in treatment type, this is to be considered only in cases with ≥5% blasts after remission induction. The results provide a basis for a prospective trial.
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144
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Krause JR, Findeis S. Mixed phenotypic acute leukemia. Proc (Bayl Univ Med Cent) 2018; 31:90-91. [PMID: 29686566 DOI: 10.1080/08998280.2017.1400317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Mixed phenotypic acute leukemias (MPALs) are a heterogeneous group of rare leukemias constituting about 1% to 5% of all leukemias. MPAL is defined as an acute leukemia that demonstrates expression of a combination of antigens of different lineages so that it is not possible to assign a single lineage to that leukemia. These leukemias have been characterized by relative therapeutic resistance. We present a case of a woman with an acute MPAL diagnosed as a B/myeloid leukemia.
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Affiliation(s)
- John R Krause
- Department of Pathology, Division of Hematopathology, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Sarah Findeis
- Department of Pathology, Division of Hematopathology, Baylor University Medical Center at Dallas, Dallas, Texas
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145
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Klairmont MM, Cheng J, Gradowski JF. AML with MDS-related changes and blasts of mixed lineage: time for a new provisional entity? Leuk Lymphoma 2018; 59:2752-2754. [PMID: 29616848 DOI: 10.1080/10428194.2018.1443451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Matthew M Klairmont
- a Department of Pathology and Laboratory Medicine , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Jinjun Cheng
- a Department of Pathology and Laboratory Medicine , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Joel F Gradowski
- a Department of Pathology and Laboratory Medicine , University of Tennessee Health Science Center , Memphis , TN , USA
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146
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Lai B, Mu Q, Zhu H, Wang Y, Zhang Y, Xu K, Sheng L, Ouyang G. Durable remission in a patient of mixed phenotype acute leukemia with Philadelphia chromosome-positive treated with nilotinib and lenalidomide: A case report. Medicine (Baltimore) 2018; 97:e0294. [PMID: 29620650 PMCID: PMC5902271 DOI: 10.1097/md.0000000000010294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Philadelphia chromosome-positive mixed phenotype acute leukemia (Ph+ MPAL) is a rare type of leukemia with poor prognosis. Tyrosine kinase inhibitors (TKIs) in combination with chemotherapy have significantly improved its remission rate. However, relapse remains the major obstacle to achieve long survival. Lenalidomide is a second-generation oral immunomodulatory drug that has been broadly applied in the treatment of various hematological malignancies. PATIENT CONCERNS A 54-year-old Chinese male patient who complained of chest pain and fatigue for 20 days. Bone marrow aspirate examination revealed hypercellularity with 70% blast cells. Flow cytometry analysis revealed that the blast cells exhibit both myeloid and lymphoid lineage antigens. Chromosomal analysis reveals t(9;22)(q34;q11) translocation. Minor BCR-ABL fusion gene was positive. DIAGNOSIS Philadelphia chromosome-positive mixed phenotype acute leukemia. INTERVENTIONS After relapsed from routine chemotherapy plus imatinib, the therapy was switched to oral therapy with nilotinib and lenalidomide due to his feeble condition. OUTCOMES He successfully achieved long survival after oral therapy with nilotinib and lenalidomide. LESSONS Combination of TKIs with lenalidomide may be an effective maintenance treatment regimen for Ph+ MPAL patients with minimal side effect.
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Affiliation(s)
| | - Qitian Mu
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, PR China
| | | | | | - Yi Zhang
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, PR China
| | | | | | - Guifang Ouyang
- Department of Hematology
- Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, PR China
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147
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Ma G, Wang Y, Ahmed T, Zaslav AL, Hogan L, Avila C, Wada M, Salman H. Anti-CD19 chimeric antigen receptor targeting of CD19 + acute myeloid leukemia. Leuk Res Rep 2018; 9:42-44. [PMID: 29892548 PMCID: PMC5993359 DOI: 10.1016/j.lrr.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/23/2018] [Accepted: 03/18/2018] [Indexed: 11/26/2022] Open
Abstract
Aberrant expression of CD19 in acute myeloid leukemia (AML) is commonly associated with t(8;21)(q22;q22), although AML cases lacking this translocation occasionally express CD19. Mixed-phenotype acute leukemia also frequently expresses CD19. Chimeric antigen receptor (CAR) technology is a major breakthrough for cancer treatment, with the recent approval of CD19-directed CAR (CD19CAR) for treating B-cell malignancies. However, little information exists on using CD19CAR for other CD19 positive neoplasms such as AML. Our findings indicate that CD19CAR therapy can potentially be used for those with mixed phenotype leukemia and a subset of AML cases.
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Affiliation(s)
- Gina Ma
- iCell Gene Therapeutics LLC, Research & Development Division, Long Island High Technology Incubator, 25 Health Science Drive, Stony Brook, NY 11790, United States
| | - Yi Wang
- Department of Pathology, Stony Brook Medicine, Stony Brook, NY 11794, United States
| | - Tahmeena Ahmed
- Department of Pathology, Stony Brook Medicine, Stony Brook, NY 11794, United States
| | - Ann-Leslie Zaslav
- Department of Pathology, Stony Brook Medicine, Stony Brook, NY 11794, United States
| | - Laura Hogan
- Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook University Medical Center, Stony Brook, NY 11794, United States
| | - Cecilia Avila
- Department of OB-GYN, Stony Brook Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794, United States
| | - Masayuki Wada
- iCell Gene Therapeutics LLC, Research & Development Division, Long Island High Technology Incubator, 25 Health Science Drive, Stony Brook, NY 11790, United States
| | - Huda Salman
- Department of Internal Medicine, Stony Brook Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794, United States
- Correspondence to: Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY 11794, United States.
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148
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Khan M, Siddiqi R, Naqvi K. An update on classification, genetics, and clinical approach to mixed phenotype acute leukemia (MPAL). Ann Hematol 2018; 97:945-953. [PMID: 29546454 DOI: 10.1007/s00277-018-3297-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 03/05/2018] [Indexed: 01/09/2023]
Abstract
Mixed phenotype acute leukemia (MPAL) is an uncommon diagnosis, representing only about 2-5% of acute leukemia cases. The blast cells of MPAL express multilineage immunophenotypic markers and may have a shared B/T/myeloid phenotype. Due to historical ambiguity in the diagnosis of MPAL, the genetics and clinical features of this disease remain poorly characterized. Based on the 2008 and 2016 World Health Organization classifications, myeloid lineage is best determined by presence of myeloperoxidase, while B and T lymphoid lineages are demonstrated by CD19 and cytoplasmic CD3 expression. MPAL typically carries a worse prognosis than either acute myeloid leukemia (AML) or acute lymphoid leukemia (ALL). Given the rarity of MPAL, there is a lack of prospective trial data to guide therapy; treatment generally relies on ALL-like regimens followed by consolidation chemotherapy or hematopoietic stem cell transplant (HSCT). Here, we review the updated classification, biology, clinical features, and treatment approach to MPAL.
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Affiliation(s)
- Maliha Khan
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 402, Houston, TX, 77030, USA
| | - Rabbia Siddiqi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Kiran Naqvi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 402, Houston, TX, 77030, USA.
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149
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Maruffi M, Sposto R, Oberley MJ, Kysh L, Orgel E. Therapy for children and adults with mixed phenotype acute leukemia: a systematic review and meta-analysis. Leukemia 2018; 32:1515-1528. [PMID: 29550836 DOI: 10.1038/s41375-018-0058-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/29/2017] [Accepted: 01/02/2018] [Indexed: 11/09/2022]
Abstract
The rarity of mixed-phenotype acute leukemia (MPAL) has resulted in diffuse literature consisting of small case series, thus precluding a consensus treatment approach. We conducted a meta-analysis and systematic review to investigate the association of treatment type (acute lymphoblastic leukemia [ALL], acute myeloid leukemia [AML], or "hybrid" regimens), disease response, and survival. We searched seven databases from inception through June 2017 without age or language restriction. Included studies reported sufficient treatment detail for de novo MPAL classified according to the well-established European Group for Immunological Characterization of Acute Leukemias (EGIL) or World Health Organization (WHO2008) criteria. Meta-analyses and multivariable analyses of a patient-level compiled case series were performed for the endpoints of complete remission (CR) and overall survival (OS). We identified 97 reports from 33 countries meeting criteria, resulting in 1,499 unique patients with data, of whom 1,351 had sufficient detail for quantitative analysis of the study endpoints. Using either definition of MPAL, meta-analyses revealed that AML induction was less likely to achieve a CR as compared to ALL regimens, (WHO2008 odds ratio [OR] = 0.33, 95% confidence interval [95% CI] 0.18-0.58; EGIL, OR = 0.18, 95% CI 0.08-0.40). Multivariable analysis of the patient-level data supported poorer efficacy for AML induction (versus ALL: OR = 0.45 95% CI 0.27-0.77). Meta-analyses similarly found better OS for those beginning with ALL versus AML therapy (WHO2008 OR = 0.45, 95% CI 0.26-0.77; EGIL, OR = 0.43, 95% CI 0.24-0.78), but multivariable analysis of patient-level data showed only those starting with hybrid therapy fared worse (hazard ratio [HR] = 2.11, 95% CI 1.30-3.43). MPAL definition did not impact trends within each endpoint and were similarly predictive of outcome. Using either definition of MPAL, ALL-therapy is associated with higher initial remission rates for MPAL and is at least equivalent to more intensive AML therapy for long-term survival. Prospective trials are needed to establish a uniform approach to this heterogeneous disease.
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Affiliation(s)
- Maria Maruffi
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Kaiser Permanente-Oakland Medical Center, Oakland, CA, USA
| | - Richard Sposto
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Matthew J Oberley
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lynn Kysh
- Norris Medical Library, University of Southern California, Los Angeles, CA, USA
| | - Etan Orgel
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, USA. .,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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150
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Gutierrez A, Kentsis A. Acute myeloid/T-lymphoblastic leukaemia (AMTL): a distinct category of acute leukaemias with common pathogenesis in need of improved therapy. Br J Haematol 2018; 180:919-924. [PMID: 29441563 DOI: 10.1111/bjh.15129] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/20/2017] [Indexed: 02/02/2023]
Abstract
Advances in the classification of acute leukaemias have led to improved outcomes for a substantial fraction of patients. However, chemotherapy resistance remains a major problem for specific subsets of acute leukaemias. Here, we propose that a molecularly distinct subtype of acute leukaemia with shared myeloid and T cell lymphoblastic features, which we term acute myeloid/T-lymphoblastic leukaemia (AMTL), is divided across 3 diagnostic categories owing to variable expression of markers deemed to be defining of myeloid and T-lymphoid lineages, such as myeloperoxidase and CD3. This proposed diagnostic group is supported by (i) retained myeloid differentiation potential during early T cell lymphoid development, (ii) recognition that some cases of acute myeloid leukaemia (AML) harbour hallmarks of T cell development, such as T-cell receptor gene rearrangements and (iii) common gene mutations in subsets of AML and T cell acute lymphoblastic leukaemia (T-ALL), including WT1, PHF6, RUNX1 and BCL11B. This proposed diagnostic entity overlaps with early T cell precursor (ETP) T-ALL and T cell/myeloid mixed phenotype acute leukaemias (MPALs), and also includes a subset of leukaemias currently classified as AML with features of T-lymphoblastic development. The proposed classification of AMTL as a distinct entity would enable more precise prospective diagnosis and permit the development of improved therapies for patients whose treatment is inadequate with current approaches.
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Affiliation(s)
- Alejandro Gutierrez
- Division of Hematology/Oncology, Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Alex Kentsis
- Molecular Pharmacology Program, Sloan Kettering Institute, and Department of Pediatrics, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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