Olga Zając-Spychała1, Ninela Irga-Jaworska2, Elżbieta Drożyńska2, Katarzyna Muszyńska-Rosłan3, Maryna Krawczuk-Rybak3, Joanna Zawitkowska4, Jerzy Kowalczyk4, Magdalena Ćwiklińska5, Walentyna Balwierz5, Agnieszka Mizia-Malarz6, Wanda Badowska7, Elżbieta Kamieńska8, Tomasz Urasiński8, Aneta Kaczorowska9, Bernarda Kazanowska9, Alicja Chybicka9, Mariusz Wysocki10, Łukasz Sędek11, Tomasz Szczepański11, Mariola Woszczyk12, Michał Matysiak13, Wojciech Młynarski14, Grażyna Karolczyk15, Radosław Chaber16, Jacek Wachowiak1. 1. Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland. 2. Department of Pediatrics, Hematology and Oncology, Medical University, Gdansk, Poland. 3. Department of Pediatric Oncology and Hematology, Medical University, Bialystok, Poland. 4. Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland. 5. Department of Pediatric Oncology and Hematology, University Children's Hospital, Jagiellonian University, Krakow, Poland. 6. Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, Katowice, Poland. 7. Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland. 8. Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland. 9. Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland. 10. Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland. 11. Department of Pediatric Hematology and Oncology, Silesian Medical University, Zabrze, Poland. 12. Division of Pediatric Hematology and Oncology, Chorzow Pediatric and Oncology Center, Chorzow, Poland. 13. Department of Pediatric Hematology and Oncology, Medical University, Warszawa, Poland. 14. Department of Pediatric Oncology, Hematology and Diabetology, Medical University, Lodz, Poland. 15. Division of Pediatric Hematology and Oncology, Children Hospital, Kielce, Poland. 16. Department of Pediatric Oncohematology, Children Hospital, Rzeszow, Poland.
Abstract
OBJECTIVES: The aim of this population-based, retrospective study was to analyze biological and clinical features and treatment results in children diagnosed with MPAL in all Polish pediatric oncology centers between 2007 and 2018. METHODS: Among 2893 children and adolescents diagnosed and treated for acute leukemia, 39 (1.35%) patients fulfilled the WHO criteria of MPAL. The T/myeloid phenotype was most prevalent. RESULTS: Cytogenetics findings were seen in 2 (5.1%), while chromosomal abnormalities were found in 14 (35.9%) patients. Thirty-two patients achieved CR-1, including 23 (92.0%) treated with ALL-directed chemotherapy and 9 (64.3%) treated with AML-type induction regimens. Within these patients, 4 (12.5%) died due to treatment-related complications and 11 (34.4%) relapsed. Nineteen (63.3%) patients underwent allo-HSCT in CR-1 and 14 (73.7%) of them have been in CR-1. In total, 17 (43.6%) patients remain in CR-1 for 1-12 years, including 14 (58.3%) with T/myeloid MPAL. The 5-year pOS and pEFS were 51.8% and 44.2%, respectively. The overall survival for ALL-directed therapy was significantly better than the one for AML-type chemotherapy (P = .001). It was also better for patients who underwent HSCT in CR-1 (P = .001). CONCLUSIONS: The prognosis of MPAL is unsatisfactory, but initial treatment with ALL-directed chemotherapy consolidated with allo-HSCT improves the outcomes in MPAL.
OBJECTIVES: The aim of this population-based, retrospective study was to analyze biological and clinical features and treatment results in children diagnosed with MPAL in all Polish pediatric oncology centers between 2007 and 2018. METHODS: Among 2893 children and adolescents diagnosed and treated for acute leukemia, 39 (1.35%) patients fulfilled the WHO criteria of MPAL. The T/myeloid phenotype was most prevalent. RESULTS: Cytogenetics findings were seen in 2 (5.1%), while chromosomal abnormalities were found in 14 (35.9%) patients. Thirty-two patients achieved CR-1, including 23 (92.0%) treated with ALL-directed chemotherapy and 9 (64.3%) treated with AML-type induction regimens. Within these patients, 4 (12.5%) died due to treatment-related complications and 11 (34.4%) relapsed. Nineteen (63.3%) patients underwent allo-HSCT in CR-1 and 14 (73.7%) of them have been in CR-1. In total, 17 (43.6%) patients remain in CR-1 for 1-12 years, including 14 (58.3%) with T/myeloid MPAL. The 5-year pOS and pEFS were 51.8% and 44.2%, respectively. The overall survival for ALL-directed therapy was significantly better than the one for AML-type chemotherapy (P = .001). It was also better for patients who underwent HSCT in CR-1 (P = .001). CONCLUSIONS: The prognosis of MPAL is unsatisfactory, but initial treatment with ALL-directed chemotherapy consolidated with allo-HSCT improves the outcomes in MPAL.