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Unmanipulated haploidentical hematopoietic stem cell transplantation for mixed phenotype acute leukemia: a single center study

Bone Marrow Transplantation volume 59, pages 147–149 (2024)Cite this article

Subjects

Categorized as a rare subtype of acute leukemia with a generally dismal prognosis, mixed-phenotype acute leukemia (MPAL) comprises blast cells of multilineage origin, or blasts that express at least two lineage-specific markers [1, 2]. The incidence of MPAL is 0.35 cases/1,000,000 person-years and accounts for only 1.6% of acute leukemias [3]. MPAL has a much worse prognosis than acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML), and had a higher predicted relapse rate in one meta-analysis [4]. Due to the rarity and dismal long-term survival of MPAL, there are currently neither evidence-based guidelines nor prospective clinical trials that have definitively addressed best management practices for the condition [5]. Most MPAL study groups and experts tended to believe that hemopoietic stem cell transplantation (HSCT) is the most effective curative treatment. Previous reports on the subject have mainly focused on matched sibling donor- (MSD-) or matched unrelated donor- (MUD-) HSCT [6,7,8]. Haploidentical HSCT had been reported to have promising OS and event-free survival (EFS) rates for both AML and ALL, owing to a stronger graft-versus-leukemia effect. Haploidentical donors are available to nearly all patients who require allo-HSCT, especially for those who are in urgent need of allo-HSCT. For MPAL patients who lack matched donors, alternative donor transplantation should be considered. In this study, we report on the safety and efficacy of HSCT with haploidentical donors for treating 33 MPAL patients.

Thirty-three MPAL patients undergoing HSCT at the Peking University Institute of Hematology, Peking University People’s Hospital (Beijing, China) between December 2017 and April 2022 were enrolled in this study. Parents or guardians of the patients were fully informed and provided written consent for HSCT. The diagnostic criteria for MPAL were adapted from the WHO. Karyotype analysis was conducted at the time of initial diagnosis in 84.8% (28/33) of the patients. The remaining five patients were not evaluated for various reasons: one had a normal karyotype with <20 analyzed metaphases, and karyotype information was not available for the other four.

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Fig. 1: Transplant outcomes.

Data availability

The original contributions presented in the study are included in the article/ Supplementary Material. Further inquiries can be directed to the corresponding authors.

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Acknowledgements

We want to acknowledge patients and their families for participating in the follow-up.

Funding

This work was supported by Foundation of CAMS Innovation Fund for Medical Sciences (CIFMS) (2019-I2M-5-034), the National Natural Science Foundation of China(82270227 & 82070189). Sanming Project of Medicine in Shenzhen (SZSM202011004); Science, Technology and Innovation Commission of Shenzhen Municipality(JCYJ20220530144604011); Clinical Funding of the Seventh Affiliated Hospital, Sun Yat-sen University (ZSQYLCKYJJ202024).

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Author notes

  1. These authors contributed equally: Junbin Huang, Bo Feng.

Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking-Tsinghua Center for Life Science, Research Unit of Key Technique for Diagnosis and Treatment of Hematologic Malignancies, Beijing, China

    Junbin Huang, Bo Feng, Yifei Cheng, Lanping Xu, Xiaohui Zhang, Xiaojun Huang & Yu Wang

  2. Pediatric Hematology Laboratory, Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China

    Junbin Huang

  3. Department of Hematology, Jiujiang First People’s Hospital, Jiujiang, China

    Bo Feng

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Contributions

JBH and BF collected data and drafted the initial manuscript. YW and XJH reviewed the initial manuscript. YW supervised the work. JBH, BF, YFC, LPX, XHZ, XJH and YW collected and provided patient clinical data. YW and XJH assigned the protocol, and critically revised the manuscript for relevant intellectual content. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Yu Wang.

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The authors declare no competing interests.

Ethics statement

The studies involving human participants were reviewed and approved by The Ethics Committee at Peking University People’s Hospital. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.

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Huang, J., Feng, B., Cheng, Y. et al. Unmanipulated haploidentical hematopoietic stem cell transplantation for mixed phenotype acute leukemia: a single center study. Bone Marrow Transplant 59, 147–149 (2024). https://doi.org/10.1038/s41409-023-02141-x

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