Acute mixed lineage leukemia in children

The experience of St Jude Children's Research Hospital

Jeffrey E. Rubnitz, Mihaela Onciu, Stanley Pounds, Sheila Shurtleff, Xueyuan Cao, Susana C. Raimondi, Frederick G. Behm, Dario Campana, Bassem I. Razzouk, Raul C. Ribeiro, James R. Downing, Ching Hon Pui

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

To characterize the biology and optimal therapy of acute mixed-lineage leukemia in children, we reviewed the pathologic and clinical features, including response to therapy, of 35 patients with mixed-lineage leukemia. The majority of cases (91%) had blasts cells that simultaneously expressed either T-lineage plus myeloid markers (T/myeloid, n = 20) or B-lineage plus myeloid markers (B/myeloid, n = 12). Overall survival rates for the B/myeloid and T/myeloid subgroups were not significantly different from each other or from the rate for acute myeloid leukemia (AML) but were inferior to the outcome in children with acute lymphoblastic leukemia (ALL). Patients who failed to achieve complete remission with AML-directed therapy could often be induced with a regimen of prednisone, vincristine, and L-asparaginase. Analysis of gene-expression patterns identified a subset of biphenotypic leukemias that did not cluster with T-cell ALL, B-progenitor ALL, or AML.We propose that treatment for biphenotypic leukemia begin with one course of AML-type induction therapy, with a provision for a switch to lymphoid-type induction therapy with a glucocorticoid, vincristine, and L-asparaginase if the patient responds poorly. We also suggest that hematopoietic stem cell transplantation is often not required for cure of these patients.

Original languageEnglish (US)
Pages (from-to)5083-5089
Number of pages7
JournalBlood
Volume113
Issue number21
DOIs
StatePublished - Nov 18 2009

Fingerprint

Biphenotypic Acute Leukemia
Asparaginase
Vincristine
Acute Myeloid Leukemia
T-cells
Prednisone
Stem cells
Research
Gene expression
Glucocorticoids
Leukemia
Switches
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Therapeutics
Hematopoietic Stem Cell Transplantation
Gene Expression Profiling
Survival Rate

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Rubnitz, J. E., Onciu, M., Pounds, S., Shurtleff, S., Cao, X., Raimondi, S. C., ... Pui, C. H. (2009). Acute mixed lineage leukemia in children: The experience of St Jude Children's Research Hospital. Blood, 113(21), 5083-5089. https://doi.org/10.1182/blood-2008-10-187351

Acute mixed lineage leukemia in children : The experience of St Jude Children's Research Hospital. / Rubnitz, Jeffrey E.; Onciu, Mihaela; Pounds, Stanley; Shurtleff, Sheila; Cao, Xueyuan; Raimondi, Susana C.; Behm, Frederick G.; Campana, Dario; Razzouk, Bassem I.; Ribeiro, Raul C.; Downing, James R.; Pui, Ching Hon.

In: Blood, Vol. 113, No. 21, 18.11.2009, p. 5083-5089.

Research output: Contribution to journalArticle

Rubnitz, JE, Onciu, M, Pounds, S, Shurtleff, S, Cao, X, Raimondi, SC, Behm, FG, Campana, D, Razzouk, BI, Ribeiro, RC, Downing, JR & Pui, CH 2009, 'Acute mixed lineage leukemia in children: The experience of St Jude Children's Research Hospital', Blood, vol. 113, no. 21, pp. 5083-5089. https://doi.org/10.1182/blood-2008-10-187351
Rubnitz, Jeffrey E. ; Onciu, Mihaela ; Pounds, Stanley ; Shurtleff, Sheila ; Cao, Xueyuan ; Raimondi, Susana C. ; Behm, Frederick G. ; Campana, Dario ; Razzouk, Bassem I. ; Ribeiro, Raul C. ; Downing, James R. ; Pui, Ching Hon. / Acute mixed lineage leukemia in children : The experience of St Jude Children's Research Hospital. In: Blood. 2009 ; Vol. 113, No. 21. pp. 5083-5089.
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