scholarly journals Clinical Characteristics and Outcomes of 82 Patients with Mixed-Phenotype Acute Leukemia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1124-1124
Author(s):  
Yan chun Yang ◽  
Ya Gao ◽  
Ying Xu ◽  
Yintian Zhang ◽  
Dongmao Zhu ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Lymphoblastic Leukemia ◽  
Guangdong Province ◽  
Hybrid Therapy ◽  
Mixed Phenotype Acute Leukemia ◽  
Mixed Phenotype ◽  
Acute Myeloid

Abstract Objectives: Mixed-phenotype acute leukemia(MPAL) is a rare disease and comprises 2% to 5% of all acute leukemia. Outcomes for MPAL are worse than both acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).The complex phenotype exhibited by this type of leukemia resulted in a myriad of treatment approaches.In our study, we retrospective analysis 82 patients in clinical trail, treatment strategy and prognosis. Method: eighty-two patients diagnosed with MPAL at Nan fang hospital from 2006 to 2017 using either EGIL or 2008 WHO criteria were analyzed. Comparison the treatment effect and outcomes between different therapy types. Result: eighty-two patients, including 60 males and 22 females with a median age of 29 years (range, 2 months-72 years), were studied. 61 patients (77%) were older than 18years, 73patients met the criteria for MPAL via EGIL, 68via WHO2008, and 59of these were reported to satisfy both definitions. fifty one of these cases (62.2%) had a B/myeloid phenotype, Twenty four of these cases (29.3%) had a T/myeloid phenotype. The other cases (8.5%) showed immunophenotypic evidence of a B, T, and myeloid lineage in one blast population. Among the 82 cases, 57 cases with successful cytogenetic studies, 20(35.1%) had normal karyotypes and 37patients(64.9%) had abnormal karyotypes. Twelve patients (21.05%) translocation between chromosomes 9 and 22, five (8.8%) patients had 11q23/MLL translocations. Twelve patients (21.05%) had a complex karyotype and eight patients (14%) had other karyotype. The rarity of this disease and the fact that patients with MPAL are excluded from most AML and ALL clinical trials further complicates guidance about therapy. Of the 82 cases, 75 patients underwent the complete first course of treatment and complete remission rate was 49.8%. treatment approaches utilizing therapy for acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and so-called "hybrid" therapy mixing elements of both are 51.9%, 16.7% and 66.7% respectively (P=0.003).OS and EFS with hybrid induction therapy and ALL like induction were not significantly different than those with AML induction by either definition (P>0.05). A total of 60 patients received consolidation treatment, 21 patients received the chemotherapy while 39 patients received stem cell transplant (HSC). The total Median EFS was 21months, in Chemotherapy group and HSC group, the Median EFS was 6 months and 40 months respectively, The 3-year EFS was 26.1% and 55.6% respectively (P=0.038). The total Median OS was 21 months, Median OS showed a significant survival benefit for starting with chemotherapy as compared to HSC( 12 months and 43 months respectively (P=0.001)), The 3-year OS was 19.1% and 57.7% respectively. Conclusion: In this study, ALL like induction therapy or "hybrid" therapy was associated with a more than three-fold greater CR rate than AML therapy. SCT therapy showed a trend for an association with higher OS and EFS for MPAL . Key words: MPAL, Immunophenotype,Treatment strategy Funding Key Sci-Tech Research Projects of Guangdong Province (2014A02021102). Disclosures Fan: National Natural Science Foundation of China (No. 81600141, No. 81770190) and Natural Science Foundation of Guangdong Province (No. 2016A030310390): Research Funding.

scholarly journals Uncommon CD markers in acute myeloid leukemia

2018 ◽  
Vol 11 (4) ◽  
pp. 267-269
Author(s):  
Azad Abul Kalam ◽  
Md. Rafiquzzaman Khan ◽  
A. B. M. Hassan Habib ◽  
Masuda Begum
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Lymphoblastic Leukemia ◽  
Color Flow ◽  
Mixed Phenotype Acute Leukemia ◽  
International Data ◽  
Mixed Phenotype ◽  
Cd Markers ◽  
Acute Myeloid

This study was done to assess the unusual CD expression in 100 cases of acute myeloid leukemia from October 2016 to April 2018. The age limit was from 3 to 50 years. Four color flow cytometry was used to diagnose the fresh aspirated bone marrow or peripheral blood sample of acute leukemia. The unusual lymphoid CD expression on myeloblasts was analyzed. Among the cases, 44% were acute myeloid leukemia, 52% of patients were of acute lymphoblastic leukemia and mixed phenotype acute leukemia was 4%. Aberrant CD expression was observed in 58% acute myeloid leukemia patients. Both aberrant CD5 and CD7 lymphoid markers expressed in acute myeloid leukemia patients were 4.2%. Aberrant CD7, CD5, cCD79a and cCD3 were in 45.8%, 33.3%, 8.3%, 8.3% of acute myeloid leukemia patients respectively. In acute myeloid leukemia, the frequency of aberrant CD expression was compared with recent international data.

scholarly journals Lineage switch from acute myeloid leukemia to T cell/myeloid mixed phenotype acute leukemia: First report of an adult case

2018 ◽  
Vol 93 (12) ◽  
pp. E395-E397 ◽  
Author(s):  
Brian P. Hanley ◽  
Eva Yebra-Fernandez ◽  
Renuka Palanicawandar ◽  
Eduardo Olavarria ◽  
Kikkeri N. Naresh
Keyword(s):  
Acute Myeloid Leukemia ◽  
T Cell ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Adult Case ◽  
First Report ◽  
Lineage Switch ◽  
Mixed Phenotype Acute Leukemia ◽  
Mixed Phenotype ◽  
Acute Myeloid

scholarly journals Spinal Cord Compression in Patients with Acute Myeloid and Lymphoid Leukemia

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 26-27
Author(s):  
Shehab Fareed Mohamed ◽  
Elabbass Abdelmahmuod ◽  
Elrazi Awadelkarim A Ali ◽  
Abdulqadir Jeprel Nashwan ◽  
Dina Sameh Soliman ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Spinal Cord Compression ◽  
Myeloid Leukemia ◽  
Lymphoblastic Leukemia ◽  
Cord Compression ◽  
Myeloid Sarcoma ◽  
Acute Myeloid

Introduction Acute leukemias can be divided into acute myeloid leukemia and acute lymphoblastic leukemia. Common presentations of acute leukemia include fever, symptoms of anemia, bleeding, bone pain palpable Lymph nodes or spleen and symptoms due inflation or leukocystasis. Extramedullary mass is rare and can be of myeloid tissue and known as Chloroma or myeloid (granulocytic) sarcoma which one of the WHO classifications for acute myeloid leukemia. Common sites of occurrence are skin, sinuses, bone and other. It's rarely involve central nervous system. Spinal cord involvement usually manifest as epidural mass causing cord compression. Spinal epidural tumor with acute leukemia and myeloid sarcoma is rare and can be found in 3-9% in patients with leukemia. In this review we decide to review the cases of spinal cord compression caused by acute myeloid leukemia (including Chloroma) and acute lymphoblastic leukemia due to the significance of such presentation in addition to reports that Myeloid sarcoma of the spine has very poor prognosis Methodology: We have reviewed the literature using: PubMed, google scholar, Scopus for patient with spinal cord compression and acute leukemia. We used the search term and synonyms : : acute myeloid leukemia , acute myelocytic leukemia , acute monocytic leukemia , acute lymphoblastic leukemia , acute lymphoid leukemia, chloroma , myeloid sarcoma ,granulocytic sarcoma, spinal cord compression .We included adult patients above 18 years old only cases we exclude pediatrics cases and cases of chronic leukemia's and other myeloproliferative disorders as well as cases of central nervous system involvement other than spinal cord Results We gathered the information from 98 cases with general demographics, presentation, image modality, cytogenetics and molecular in addition to management and outcome. We have found mean age for the patients is 38 years old with male predominance with 70% of the cases. The most presenting symptom was back pain in around 75% of the cases. Neurological findings showed sensory loss and parapreresis in most of the documented cases. MRI was most performed modality of imaging 63% followed by Computed tomography(CT) 15 % and then myelogram 13 %, which is least used due to invasive nature and before the era of MRI. The most common affected site on spinal cord were thoracic followed by lumbar. Cytogenetics and molecular data was not reported in most of the cases. Patients were treated with either steroids or surgery or radiotherapy and or chemotherapy while few underwent bone marrow transplant, but the most common approach was surgery+ radiotherapy + chemotherapy combination. Steroids used in most of the cases especially in the cases of acute lymphoblastic leukemia and dexamethasone was the steroids of the choice mainly. The outcome of the patients were variable, 30 % were alive at the time of the reports 30 % died and 30 % between relapse and complete remission. Conclusions Acute leukemia can be presented as mass causing spinal cord compression which is very serious. There are is no standardized management of patients with acute leukemia who presented with spinal cord compression nether guidelines or steps to follow. Some reports speculated also specific morphology and cytogenetics association with predisposition to have Extramedullary mass, however there lack of reporting of such a valuable information. Large studies including all adjusted variables required to determine if spinal cord compression presentation can be an independent risk facto or not Effective diagnosis and prompt action should take place. Figure Disclosures No relevant conflicts of interest to declare.

Acute Leukemia

2016 ◽  
Author(s):  
Richard A. Larson ◽  
Roland B Walter
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Who Classification ◽  
Lymphoblastic Leukemia ◽  
World Health ◽  
Acute Leukemias ◽  
Acute Myeloid

The acute leukemias are malignant clonal disorders characterized by aberrant differentiation and proliferation of transformed hematopoietic progenitor cells. These cells accumulate within the bone marrow and lead to suppression of the production of normal blood cells, with resulting symptoms from varying degrees of anemia, neutropenia, and thrombocytopenia or from infiltration into tissues. They are currently classified by their presumed cell of origin, although the field is moving rapidly to genetic subclassification. This review covers epidemiology; etiology; classification of leukemia by morphology, immunophenotyping, and cytogenetic/molecular abnormalities; cytogenetics of acute leukemia; general principles of therapy; acute myeloid leukemia; acute lymphoblastic leukemia; and future possibilities. The figure shows the incidence of acute leukemias in the United States. Tables list World Health Organization (WHO) classification of acute myeloid leukemia and related neoplasms, expression of cell surface and cytoplasmic markers for the diagnosis of acute myeloid leukemia and mixed-phenotype acute leukemia, WHO classification of acute lymphoblastic leukemia, WHO classification of acute leukemias of ambiguous lineage, WHO classification of myelodysplastic syndromes, European LeukemiaNet cytogenetic and molecular genetic subsets in acute myeloid leukemia with prognostic importance, cytogenetic and molecular subtypes of acute lymphoblastic leukemia, terminology used in leukemia treatment, and treatment outcome for adults with acute leukemia. This review contains 1 highly rendered figure, 9 tables, and 117 references.

scholarly journals CHARACTERISTICS CHANGES IN PRO-OXIDANT-ANTIOXIDANT STATUS IN PATIENTS WITH ACUTE LEUKEMIA DURING CHEMOTHERAPY

2020 ◽  
Vol 20 (1) ◽  
pp. 23-28
Author(s):  
H.S. Maslova ◽  
I.M. Skrypnyk ◽  
O.F. Hopko
Keyword(s):  
Lipid Peroxidation ◽  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Catalase Activity ◽  
Myeloid Leukemia ◽  
Lymphoblastic Leukemia ◽  
Thiobarbituric Acid ◽  
Thiobarbituric Acid Reactive Substances ◽  
Acute Myeloid

Changes in the processes of lipid peroxidation and antioxidant system activity are involved in the pathogenesis of carcinogenesis and can affect tumor resistance to chemotherapy. The aim of this study to investigate the nature of changes in pro-oxidant-antioxidant status in patients with acute leukemia during remission induction chemotherapy.  Materials and methods. The study involved 42 patients with newly diagnosed acute leukemia, 22 of them were diagnosed to have acute myeloid leukemia and 20 patients had acute lymphoblastic leukemia. The age range was 18-58 years, there were 19 women (45.2%) and 23 men (54.8%). The patients were divided into two groups: I (n=22) included patients with acute myeloid leukemia, who had chemotherapy modes "7+3" and "5+2" for variants M0-2 and "7+3+etoposide" or "5+2+etoposide" for M4-5 variants; II (n=20) group included patients with acute lymphoblastic leukemia, who received chemotherapy according to D. Hoelzer protocol. Hemogram parameters (red blood cells, hemoglobin, white blood cells, platelets) were evaluated at baseline and on the 28th day of chemotherapy. The concentration of thiobarbituric acid reactive substances and catalase activity in the blood serum were assessed as well. Examination of acute myeloid leukemia patients was performed before the chemotherapy, on the 4th and 28th days since chemotherapy started; acute lymphoblastic leukemia patients were examined before chemotherapy, on the 23rd and 28th days. The group of healthy individuals consisted of 20 persons, including 9 (45%) women and 11 (55%) men, aged 22-26 years. Results. The detailed clinical picture of acute leukemia was accompanied by typical changes in hemogram in the patients of both test groups, and namely, by the development of leukocytosis, anemia, thrombocytopenia. At the same time, the patients with acute myeloid leukemia and acute lymphoblastic leukemia demonstrated an increased concentration of thiobarbituric acid reactive substances in 1.8 and 1.89 times, respectively (p<0.05) that was accompanied by an increased serum catalase activity in 1.96 and 1.8 times, respectively (p<0.05) compared to healthy individuals. During "7+3" chemotherapy, acute myeloid leukemia patients were found to show thiobarbituric acid reactive substances increased in 1.9 times on the 4th day of treatment and decreased on the 28th day.The patients with acute lymphoblastic leukemia managed according to the D. Hoelzer protocol demonstrated an increased concentration of thiobarbituric acid reactive substances in the blood serum in 1.33 times on the 23rd day of treatment (p<0.05), maintaining this level up to the 28th day. The catalase activity in the patients of the comparison groups did not change. Conclusion. The debut of acute leukemia is accompanied by activation of lipid peroxidation and antioxidant system enzymes. Сhemotherapy promotes the shift of the prooxidant-antioxidant equilibrium towards the lipid peroxidation activation.

Improved Outcome With T-Cell–Depleted Bone Marrow Transplantation for Acute Leukemia

1999 ◽  
Vol 17 (5) ◽  
pp. 1545-1545 ◽  
Author(s):  
Franco Aversa ◽  
Adelmo Terenzi ◽  
Alessandra Carotti ◽  
Rita Felicini ◽  
Roberta Jacucci ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
T Cell ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Antithymocyte Globulin ◽  
Lymphoblastic Leukemia ◽  
Acute Myeloid

PURPOSE: To eliminate the risk of rejection and lower the risk of relapse after T-cell–depleted bone marrow transplants in acute leukemia patients, we enhanced pretransplant immunosuppression and myeloablation. PATIENTS AND METHODS: Antithymocyte globulin and thiotepa were added to standard total-body irradiation/cyclophosphamide conditioning. Donor bone marrows were depleted ex vivo of T lymphocytes by soybean agglutination and E-rosetting. This approach was tested in 54 consecutive patients with acute leukemia who received transplants from HLA-identical sibling donors or, in two cases, from family donors mismatched at D-DR. No posttransplant immunosuppressive treatment was given as graft-versus-host disease (GVHD) prophylaxis. RESULTS: Neither graft rejection nor GVHD occurred. Transplant-related deaths occurred in six (16.6%) of 36 patients in remission and in seven (38.8%) of 18 patients in relapse at the time of transplantation. The probability of relapse was .12 (95% confidence interval [CI], 0 to .19) for patients with acute myeloid leukemia and .28 (95% CI, .05 to .51) for patients with acute lymphoblastic leukemia who received transplants at the first or second remission. At a median follow-up of 6.9 years (minimum follow-up, 4.9 years), event-free survival for patients who received transplants while in remission was .74 (95% CI, .54 to .93) for acute myeloid leukemia patients and .59 (95% CI, .35 to .82) for acute lymphoblastic leukemia patients. All surviving patients have 100% performance status. CONCLUSION: Adding antithymocyte globulin and thiotepa to the conditioning regimen prevents rejection of extensively T-cell–depleted bone marrow. Even in the complete absence of GVHD, the leukemia relapse rate is not higher than in unmanipulated transplants.

scholarly journals Biphenotypic Acute Leukemia versus Myeloid Antigen-Positive ALL: Clinical Relevance of WHO Criteria for Mixed Phenotype Acute Leukemia

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
William A. Hammond ◽  
Pooja Advani ◽  
Rhett P. Ketterling ◽  
Daniel Van Dyke ◽  
James M. Foran ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Diagnostic Criteria ◽  
Myeloid Leukemia ◽  
Lymphoblastic Leukemia ◽  
Allogeneic Transplant ◽  
Who Criteria ◽  
Mixed Phenotype Acute Leukemia ◽  
Mixed Phenotype ◽  
Biphenotypic Acute Leukemia ◽  
Acute Myeloid

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.

scholarly journals Sociodemographic Disparities in Chemotherapy and Hematopoietic Cell Transplantation Utilization Among Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2374-2374
Author(s):  
Matthew J. Wieduwilt ◽  
Brice Jabo ◽  
Maria Elena Martinez ◽  
Mark Ghamsary ◽  
John W. Morgan
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Cell Transplantation ◽  
Myeloid Leukemia ◽  
Hematopoietic Cell Transplantation ◽  
Lymphoblastic Leukemia ◽  
Hematopoietic Cell ◽  
Transplant Center ◽  
Acute Myeloid

Abstract Introduction:Chemotherapy and hematopoietic cell transplantation (HCT) are cornerstones of therapy for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Identifying sociodemographic factors affecting utilization of chemotherapy and HCT may help improve outcomes for more patients with acute leukemia. Methods: Using the California Cancer Registry, we performed a retrospective population-based study of treatment administration in patients ≥15 years of age diagnosed with ALL (n=3,221) or AML (n=10,029) between 1/2003 and 12/2012. The effect of age, sex, race/ethnicity, marital status, neighborhood socioeconomic status (nSES), and distance from nearest transplant center on the receipt of no treatment, chemotherapy alone, or chemotherapy followed by HCT was assessed. Chemotherapy and HCT were common events ensuring that odds ratios for treatment would overestimate relative risk (RR). Log-binomial and negative binomial regression models did not converge so Poisson regression with robust confidence intervals was used to estimate crude and adjusted RR with 95 percent confidence interval limits (CIs). Model fitness assumption using Pearson's chi-squared tests did not reveal over dispersion. Testing for multicollinearity showed no highly correlated covariates. Influence analysis did not identify influential observations or critical outliers. The Cochran-Armitage test for trend was used to assess changes in treatment utilization over time. Predictors were selected a priori based on published studies. Google maps API was used to compute the shortest driving distance between place of residence and nearest transplant centers. All statistical tests were 2-sided and conducted at a significance level of 0.05. Results: Patients <60 years of age comprised 75.5% of ALL and 31.5% of AML patients. Females represented 43% of ALL and 45% of AML patients. ALL represented 47.3% of acute leukemia cases in Hispanics versus 20.5%, 19.0% and 15.6% in Asian/other, non-Hispanic blacks, and non-Hispanic whites, respectively. Among ALL patients, 11%, 75% and 14% received no treatment, chemotherapy, or chemotherapy followed by HCT, respectively. For AML patients, 36% received no treatment while 53% and 11% were treated with chemotherapy or chemotherapy followed by HCT, respectively. HCT rates were highest in 40-59 year-old (yo) ALL patients (21.3%) and 15-39 yo AML patients (31.3%). Only 3.4% of ALL patients and 3.6% of AML patients over ≥60 yo underwent HCT. Covariate-adjusted findings showed a decreasing RR of chemotherapy with increasing age for ALL (trend p <0.001) and AML (trend p <0.001). Compared to 40-59 yos, those ≥60 years of age had reduced utilization of chemotherapy and HCT [ALL, RR 0.20 (95% CI=0.14-0.29); AML, RR 0.23 (95% CI=0.20-0.26)]. Overall, older acute leukemia patients showed increasing utilization of chemotherapy and HCT over the study period. For ALL patients ≥60 yo, chemotherapy utilization was stable (p=0.38) while HCT utilization increased from 5% in 2005 to 9% in 2012 (p=0.03). Among AML patients ≥60 yo, chemotherapy utilization increased from 39% in 2003 to 58% in 2012 (p<0.001) and HCT utilization from 5% in 2003 to 9% in 2012 (p<0.001). Relative to non-Hispanic whites, lower HCT utilization was observed in Hispanic white [ALL, RR=0.80 (95% CI =0.65-0.98); AML, RR=0.86 (95% CI =0.75-0.99)] and non-Hispanic black patients [ALL, RR=0.40 (95% CI =0.18-0.89); AML, RR=0.60 (95% CI =0.44-0.83)]. Compared to married patients, never married patients had a lower RR of receiving chemotherapy [ALL, RR=0.96 (95% CI=0.92-0.99); AML, RR=0.94 (95% CI=0.90-0.98)] or HCT [ALL, RR=0.58 (95% CI=0.47-0.71); AML, RR=0.80 (95% CI=0.70-0.90)]. Lower nSES quintiles predicted lower chemotherapy and HCT utilization for ALL and AML (Trend p <0.001).For ALL and AML, the lowest SES quintile had a lower RR of chemotherapy [ALL, RR= 0.95 (95% CI 0.90-0.99); AML, RR=0.89 (95% CI 0.84-0.94)] and HCT [ALL, RR=0.63 (95% CI 0.47-0.84); AML, RR=0.52 (95% CI 0.43-0.64)] compared to the highest nSES quintile. Distance from a transplant center had no impact on the receipt of chemotherapy or HCT. Conclusions : Older age, lower neighborhood SES, and being unmarried predicted lower utilization of both chemotherapy and HCT among ALL and AML patients. Addressing these disparities may increase utilization of known curative therapies and improve survival in underserved acute leukemia patients. Disclosures No relevant conflicts of interest to declare.

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