Mixed-phenotype acute leukemia: A cohort and consensus research strategy from the Children’s Oncology Group Acute Leukemia of Ambiguous Lineage Task Force

Orgel E, Alexander TB, Wood BL, Kahwash SB, Devidas M, Dai Y, Alonzo TA, Mullighan CG, Inaba H, Hunger SP, Raetz EA, Gamis AS, Rabin KR, Carroll AJ 3rd, Heerema NA, Berman JN, Woods WG, Loh ML, Zweidler-McKay PA, Horan JT. Mixed-phenotype acute leukemia: A cohort and consensus research strategy from the Children’s Oncology Group Acute Leukemia of Ambiguous Lineage Task Force. Cancer. 2020 Feb 1;126(3):593-601. doi: 10.1002/cncr.32552. Epub 2019 Oct 29. PubMed PMID: 31661160; PubMed Central PMCID: PMC7489437.

Optimal chemotherapy and the role for hematopoietic stem cell transplantation (HSCT) to treat mixed phenotype acute leukemia’s (MPAL) remain uncertain. A major limitation in interpreting available data is MPAL’s rarity and the use of definitions other than the current widely accepted criteria: the World Health Organization 2016 (WHO2016) classification. To assess the relative efficacy of chemotherapy type to treat pediatric MPAL, the Children’s Oncology Group (COG) Acute Leukemia of Ambiguous Lineage Task Force assembled a retrospective cohort of centrally-reviewed WHO2016 MPAL cases selected from banking studies for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Patients were not treated on COG trials; treatment and outcome data were captured separately. We then integrated our findings with the available, mixed literature to develop a prospective trial in pediatric MPAL.