Prognostic impact of Philadelphia chromosome in mixed phenotype acute leukemia (MPAL): A cancer registry analysis on real-world outcome

Ayman Qasrawi, Reshma Ramlal, Reinhold Munker, Gerhard C. Hildebrandt

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Mixed phenotype acute leukemia (MPAL) is thought to have poor outcome, and presence of the Philadelphia chromosome (Ph+) has been considered to be an adverse prognostic marker. However, most of these reports were in the pre-tyrosine kinase inhibitors (TKIs) era. Recent limited reports indicate improved outcomes for MPAL with the addition of TKIs. We examined the outcomes of 241 cases of MPAL according to the 2008 WHO classification from the Surveillance, Epidemiology, and End Results registry. The MLL+ patients had a median age of 6 years while other subtypes occurred mostly in adults and had comparable age. On multivariate analyses and after adjustment for age, year of diagnosis and chemotherapy status, Ph+ MPAL patients had reduced risk of death in comparison to Ph(–) MPAL patients (hazard ratio [HR] = 0.28, P =.002). So, MLL+ MPAL had the worst outcome with a 10-fold increased risk of death in comparison to Ph+ MPAL patients (HR = 10.2, P <.001). Importantly, the outcome of Ph+ MPAL was comparable to Ph+ acute lymphoblastic leukemia in a 1:1 matched case-control analysis. In conclusion, this is the largest registry study which examines the outcomes of MPAL subtypes. We confirm that MPAL is a heterogenous disease. Note, Ph+ MPAL nowadays has a better OS in comparison to other subtypes and is comparable to Ph+ ALL patients. This is most likely secondary to changes in practice and more utilization of TKIs. On the other hand, MLL rearrangement is associated with infantile MPAL and has a dismal prognosis.

Original languageEnglish
Pages (from-to)1015-1021
Number of pages7
JournalAmerican Journal of Hematology
Issue number9
StatePublished - Sep 1 2020

Bibliographical note

Funding Information:
GCH reports equity ownership from Sangamo Bioscience, Celgene/Juno, Kite Pharmaceuticals, Novartis, Insys Therapeutics, AbbVie, GW Pharmaceuticals, Cardinal Health, Immunomedics, Endocyte, Clovis Oncology, Cellectis, Aetna, CVS Health, Celgene, Bluebird Bio, Bristol‐Myers Squibb/Medarex, Crispr Therapeutics, IDEXX Laboratories, Johnson & Johnson, Pfizer, Procter & Gamble, Vertex, and Jazz Pharmaceuticals, consultancy from Pfizer, Kite Pharmaceuticals, Incyte, and Jazz Pharmaceuticals, research funding from Takeda, Jazz Pharmaceuticals, and Pharmacyclin, travel, accommodations, or expenses from Kite Pharmaceuticals, Incyte, Pfizer, Falk Foundation, Jazz Pharmaceuticals, and Astellas.

Publisher Copyright:
© 2020 Wiley Periodicals LLC.

ASJC Scopus subject areas

  • Hematology


Dive into the research topics of 'Prognostic impact of Philadelphia chromosome in mixed phenotype acute leukemia (MPAL): A cancer registry analysis on real-world outcome'. Together they form a unique fingerprint.

Cite this