ABSTRACT The rarity of mixed-phenotype acute leukemia (MPAL) has resulted in diffuse literature consisting of small case series, thus precluding a consensus treatment approach. We conducted

a meta-analysis and systematic review to investigate the association of treatment type (acute lymphoblastic leukemia [ALL], acute myeloid leukemia [AML], or “hybrid” regimens), disease

response, and survival. We searched seven databases from inception through June 2017 without age or language restriction. Included studies reported sufficient treatment detail for de novo

MPAL classified according to the well-established European Group for Immunological Characterization of Acute Leukemias (EGIL) or World Health Organization (WHO2008) criteria. Meta-analyses

MPAL, meta-analyses revealed that AML induction was less likely to achieve a CR as compared to ALL regimens, (WHO2008 odds ratio [OR] = 0.33, 95% confidence interval [95% CI] 0.18–0.58;

EGIL, OR = 0.18, 95% CI 0.08–0.40). Multivariable analysis of the patient-level data supported poorer efficacy for AML induction (versus ALL: OR = 0.45 95% CI 0.27–0.77). Meta-analyses

similarly found better OS for those beginning with ALL versus AML therapy (WHO2008 OR = 0.45, 95% CI 0.26–0.77; EGIL, OR = 0.43, 95% CI 0.24–0.78), but multivariable analysis of

patient-level data showed only those starting with hybrid therapy fared worse (hazard ratio [HR] = 2.11, 95% CI 1.30–3.43). MPAL definition did not impact trends within each endpoint and

were similarly predictive of outcome. Using either definition of MPAL, ALL-therapy is associated with higher initial remission rates for MPAL and is at least equivalent to more intensive AML

therapy for long-term survival. Prospective trials are needed to establish a uniform approach to this heterogeneous disease. Access through your institution Buy or subscribe This is a

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LEUKEMIANET-DEFINED PRIMARY REFRACTORY ACUTE MYELOID LEUKEMIA: THE VALUE OF ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT AND OVERALL RESPONSE Article Open access 17 January 2022 FIRST

REPORT FROM A SINGLE CENTER RETROSPECTIVE STUDY IN KAZAKHSTAN ON ACUTE MYELOID LEUKEMIA TREATMENT OUTCOMES Article Open access 14 December 2021 MAYO CLINIC EXPERIENCE WITH 1123 ADULTS WITH

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AUTHOR CONTRIBUTIONS: E.O. conceived the study; E.O., M.M., and L.K. designed the study; L.K. designed the search strategy and conducted the search; E.O., M.M. reviewed literature and

extracted data; R.S. conducted the statistical analyses; E.O., M.M, M.O. and R.S. interpreted the analyses; M.M. wrote the first draft of the paper; all authors reviewed, edited, and

approved the final manuscript. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA, USA Maria

Maruffi, Richard Sposto & Etan Orgel * Kaiser Permanente-Oakland Medical Center, Oakland, CA, USA Maria Maruffi * Keck School of Medicine, University of Southern California, Los Angeles,

CA, USA Richard Sposto, Matthew J Oberley & Etan Orgel * Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA Matthew J Oberley *

Norris Medical Library, University of Southern California, Los Angeles, CA, USA Lynn Kysh Authors * Maria Maruffi View author publications You can also search for this author inPubMed Google

Scholar * Richard Sposto View author publications You can also search for this author inPubMed Google Scholar * Matthew J Oberley View author publications You can also search for this

author inPubMed Google Scholar * Lynn Kysh View author publications You can also search for this author inPubMed Google Scholar * Etan Orgel View author publications You can also search for

this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Etan Orgel. ETHICS DECLARATIONS CONFLICT OF INTEREST: The authors declare that they have no conflict of interest.

ELECTRONIC SUPPLEMENTARY MATERIAL SUPPLEMENTAL METHODS (REVISED) SUPPLEMENTAL DATA (REVISED) RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Maruffi, M.,

Sposto, R., Oberley, M.J. _et al._ Therapy for children and adults with mixed phenotype acute leukemia: a systematic review and meta-analysis. _Leukemia_ 32, 1515–1528 (2018).

https://doi.org/10.1038/s41375-018-0058-4 Download citation * Received: 13 September 2017 * Revised: 29 November 2017 * Accepted: 02 January 2018 * Published: 27 February 2018 * Issue Date:

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