Analyses of transplantation outcomes for adult patients with mixed-phenotype acute leukemia

Mixed-phenotype acute leukemia (MPAL) is associated with poor prognosis. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) can achieve long-term survival, optimal transplantation strategies remain unclear. We analyzed a national registry of adult patients with MPAL who underwent allo-HSCT between 2008 and 2022 in Japan. Among 417 patients, median age at transplant was 44 years (interquartile range, 32-55); 61% were male, 20% were <i>BCR::ABL1</i>-positive, and 66% underwent transplant during the first complete remission (CR; CR1). At 5 years posttransplant, overall survival (OS) was 54%, disease-free survival was 49%, relapse was 28%, and nonrelapse mortality was 23%. Multivariate analysis identified older age (adjusted hazard ratio [aHR], 1.78 [95% confidence interval (CI), 1.11-2.84] for ages 50-59 years; aHR, 2.65 [95% CI, 1.54-4.55] for ≥60 years; both vs <40 years), male sex (aHR, 1.56; 95% CI, 1.07-2.27), Eastern Cooperative Oncology Group performance status scale ≥2 (aHR, 3.05; 95% CI, 1.72-5.40), <i>BCR::ABL1</i> -negative status (aHR, 1.64; 95% CI, 1.02-2.64), advanced disease status (aHR, 1.642 [95% CI, 0.80-3.36] for second CR; aHR, 4.01 [95% CI, 2.61-6.15] for third or higher CR, or non-CR vs CR1), and low conditioning intensity (aHR, 2.49 [95% CI, 1.21-5.13] for low transplant conditioning intensity [TCI] vs high TCI) as adverse prognostic factors for OS. A propensity score-matched comparison with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) during the same period showed that MPAL did not have significantly worse prognosis than AML or ALL. These findings suggest that allo-HSCT offers long-term survival in MPAL, with outcomes not inferior to those of AML and ALL.

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Journal
Blood Neoplasia
Published
2025-08-25
DOI
https://doi.org/10.1016/j.bneo.2025.100166
Primary Topic
Acute Lymphoblastic Leukemia research
Type
article
Field-Weighted Citation Impact
0.00

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article

Analyses of transplantation outcomes for adult patients with mixed-phenotype acute leukemia

Masatsugu Tanaka, Naoyuki Uchida, Yoshinobu Kanda, Yuta Katayama et al.
Blood Neoplasia
Acute Lymphoblastic Leukemia research
article

Analyses of transplantation outcomes for adult patients with mixed-phenotype acute leukemia

Masatsugu Tanaka, Naoyuki Uchida, Yoshinobu Kanda, Yuta Katayama, Yuta Hasegawa, Masamitsu Yanada, Noriko Doki, Tadakazu Kondo, Shinichi Kako, Tetsuya Nishida, Shohei Mizuno, Yoshiko Atsuta, Tomoyasu Jo, Satoshi Yoshihara, Yasuyuki Arai, Marie Ohbiki, Masashi Sawa, Takahiro Fukuda, Koji Kawamura, Satoru Takada
article en

Abstract

Mixed-phenotype acute leukemia (MPAL) is associated with poor prognosis. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) can achieve long-term survival, optimal transplantation strategies remain unclear. We analyzed a national registry of adult patients with MPAL who underwent allo-HSCT between 2008 and 2022 in Japan. Among 417 patients, median age at transplant was 44 years (interquartile range, 32-55); 61% were male, 20% were <i>BCR::ABL1</i>-positive, and 66% underwent transplant during the first complete remission (CR; CR1). At 5 years posttransplant, overall survival (OS) was 54%, disease-free survival was 49%, relapse was 28%, and nonrelapse mortality was 23%. Multivariate analysis identified older age (adjusted hazard ratio [aHR], 1.78 [95% confidence interval (CI), 1.11-2.84] for ages 50-59 years; aHR, 2.65 [95% CI, 1.54-4.55] for ≥60 years; both vs <40 years), male sex (aHR, 1.56; 95% CI, 1.07-2.27), Eastern Cooperative Oncology Group performance status scale ≥2 (aHR, 3.05; 95% CI, 1.72-5.40), <i>BCR::ABL1</i> -negative status (aHR, 1.64; 95% CI, 1.02-2.64), advanced disease status (aHR, 1.642 [95% CI, 0.80-3.36] for second CR; aHR, 4.01 [95% CI, 2.61-6.15] for third or higher CR, or non-CR vs CR1), and low conditioning intensity (aHR, 2.49 [95% CI, 1.21-5.13] for low transplant conditioning intensity [TCI] vs high TCI) as adverse prognostic factors for OS. A propensity score-matched comparison with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) during the same period showed that MPAL did not have significantly worse prognosis than AML or ALL. These findings suggest that allo-HSCT offers long-term survival in MPAL, with outcomes not inferior to those of AML and ALL.

Blood NeoplasiaVol. 2(4)
Jichi Medical University (JP), Aichi Medical University (JP), Kanagawa Prefectural Hospital Organization (JP), Tokyo Metropolitan Komagome Hospital (JP), Nagoya City University (JP), Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital (JP), Japanese Red Cross Nagoya Daiichi Hospital (JP), Gunma Saiseikai Maebashi Hospital (JP), Hokkaido University Hospital (JP), Anjo Kosei Hospital (JP), Kyoto University Hospital (JP), The Japanese Data Center for Hematopoietic Cell Transplantation (JP), Kobe City Medical Center General Hospital (JP), Jichi Medical University Saitama Medical Center (JP), Toranomon Hospital (JP), Kanagawa Cancer Center, Tottori University (JP), Hyogo University (JP)
Japan Society for the Promotion of Science
Openalex Percentile: Top 70%
Acute Lymphoblastic Leukemia research
DOIOpen Access PDFOpenAlex
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