Prognosis of children with mixed phenotype acute leukemia treated on the basis of consistent immunophenotypic criteria

Mejstříková, Ester; Volejnikova, Jana; Froňková, Eva; Zdrahalova, Katerina; Kalina, Tomáš; Štěrba, Jaroslav; Jabali, Yahia; Mihál, Vladimı́r; Blažek, Bohumír; Černá, Zuzana; Procházková, D.; Hak, Jiří; Zemanová, Zuzana; Jarošová, Marie; Oltová, Alexandra; Sedláček, Petr; Schwarz, Jiřı́; Zuna, Jan; Trka, Jan; Starý, Jan; Hrušák, Ondřej

doi:10.3324/haematol.2009.014506

Cited by 61 publications

(68 citation statements)

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“…133 Several retrospective analyses show that ALL-directed therapy is very effective in patients with a dominant lymphoblastic phenotype. 134,135 Recommendation MPAL should be treated according to the dominant lineage defined by genetics, morphology, cytochemistry, and immunophenotyping. …”

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Diagnosis and management of acute myeloid leukemia in children and adolescents: recommendations from an international expert panel

Creutzig

Heuvel‐Eibrink

Gibson

et al. 2012

Blood

449

504

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IntroductionChildhood acute myeloid leukemia (AML) is a rare and heterogeneous disease, with an incidence of 7 cases per million children younger than 15 years. In high-income countries, intensive therapy in conjunction with effective supportive care has increased survival rates to ϳ 70%. In 1990 and 2003, expert working groups made recommendations for diagnosis, outcomes, standardization of response criteria, and reporting standards for AML. 1,2 Recent improvements in identifying the molecular genetics and pathogenesis of AML have been implemented in the new World Health Organization (WHO) classification of AML. 3 These changes, and the definition of new diagnostic and prognostic markers and their associated targeted therapies, have prompted the update of earlier recommendations by an international group, on behalf of the European LeukemiaNet for AML in adults in 2010. 4 Despite broad overlap in the diagnostic and treatment recommendations for AML for children and adults, there are important differences in both the diagnostic criteria and disease management, which merit age-specific recommendations. The absence of published recommendations specific for pediatric AML motivated an international group of pediatric hematologists and oncologists (panel and participating groups see "Appendix") to develop evidence-and expert opinionbased consensus recommendations for the diagnosis and management of AML in children, incorporating emerging information on the biology of the disease. The scope of the review is presented in the "Appendix." Recommendations for specific subgroups are also included. This article discusses diagnostic procedures and initial workup, prognostic factors, response criteria, and management, and in particular focuses on differences between adults and children with AML. For personal use only. on May 12, 2018. by guest www.bloodjournal.org From WHO classification and pediatric AMLThe recent WHO 2008 classification is applicable to both adult and pediatric AML 3,5 and has been summarized by Döhner et al. 4 The classification contains most, but not all, cytogenetic subgroups specific to children. Differences in genetic background between children and adults are given in Table 1 and discussed further in "Cytogenetics."Compared with previous classifications (European Group of Immunologic Characterization of Leukemias [EGIL], WHO 2001), 6 the new WHO classification introduced a stringently defined subclass of acute leukemias of ambiguous lineage (mixed phenotype acute leukemias [MPALs]), mainly on the basis of detailed immunophenotypic criteria (Table 2) or presence of t(9;22)(q34; q11.2)/BCR-ABL1 or t(v;11q23)/MLL rearrangement. 3,5,6 The new classification aims to create uniform subgroups defined by unifying molecular targets, which allow selection of specific treatment. Diagnostic procedures and initial workupThe minimal diagnostic requirements in childhood AML are morphology with cytochemistry, immunophenotyping, karyotyping, FISH, and specific molecular genetics in the bone marrow, which is comparable ...

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confidence: 99%

Diagnosis and management of acute myeloid leukemia in children and adolescents: recommendations from an international expert panel

Creutzig

Heuvel‐Eibrink

Gibson

et al. 2012

Blood

449

504

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“…Diagnostics in the Czech Republic improved remarkably in the 1990s with gradual introduction of centralised fl ow cytometry and molecular genetic analysis in one reference laboratory (CLIP = Childhood Leukaemia Investigation Prague), which since then has become an internationally respected research centre [15][16][17][18][19][20][21][22]. Karyotype was analysed in specialised cytogenetic laboratories in 6 out of 8 centres [23,24].…”

Section: Resultsmentioning

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History of treatment and long-term outcome in children with acute lymphoblastic leukemia in the Czech Republic

Starý

Mihál

Smíšek

et al. 2011

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“…lineage switch, czyli zmianę fenotypu komórek w przypadku wznowy choroby [18]. Obecnie lineage switch definiowane jest jako zmiana immunofenotypu komó-rek białaczkowych podczas leczenia indukującego remisję i zazwyczaj analizowane jako osobna podgrupa [8,13].…”

Section: Ostra Białaczka Bifenotypowaunclassified

“…Chorobę tę począt-kowo nazwano ,,białaczką komórki pnia z możliwością różnicowania w kierunku komórki limfo-i mieloidalnej'', a następnie ostrą białaczką bifenotypową (biphenotypic acute leukemia; BAL) [4], określaną w literaturze również jako ostra białaczka mieszana (hybrid acute leukemia; HAL) [5], ostra białaczka mieszanoliniowa (acute mixed lineage leukaemia; AMLL) [6][7][8], ostra białaczka dwuliniowa (acute bilineal leukemia; ABLL) [9,10], ostra białaczka biklonalna (acute biclonal leukemia; ABL) [5], ostra białaczka niezidentyfikowana (acute ambiguous leukemia; AAL) [9][10][11], ostra białaczka z niezidentyfikowanej linii (acute leukemia of ambiguous lineage; ALAL) [12], a ostatnio -ostra białaczka o mieszanym fenotypie (mixed phenotype acute leukemia; MPAL) [13,14].…”

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Ostra białaczka o mieszanym fenotypie – jak rozpoznać, jak leczyć?

Konatkowska

Zając‐Spychała

Wachowiak

2013

Acta Haematologica Polonica

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Ostra białaczka (acute leukemia; AL) jest najczęstszym nowotworem złośliwym występującym u dzieci. Stanowi około 35-40% nowych rozpoznań choroby rozrostowej wieku rozwojowego. Do lat 80. XX wieku dzielono ją na dwa podstawowe typy -ostrą białaczkę limfoblastyczną (acute lymphoblastic leukemia; ALL), rozpoznawaną u około 85% dzieci z AL, i mieloblastyczną (acute myeloblastic leukemia; AML), stanowiącą około 15% ostrych białaczek u dzieci. Wówczas choroby te rozpoznawano na podstawie mikroskopowo-świetlnej morfologii komórek białaczkowych oraz specyficznych barwień cytochemicznych preparatów szpiku kostnego. Po wprowadzeniu do diagnostyki immunofenotypizacji komórek białaczkowych stwierdzono, że w niektórych przypadkach wspomniane komórki wykazują a c t a h a e m a t o l o g i c a p o l o n i c a 4 4 ( 2 0 1 3 ) 2 1 5 -2 2 1 i n f o r m a c j e o a r t y k u l e Historia artykułu: Otrzymano: 31.Słowa kluczowe: ostra białaczka bifenotypowa ostra białaczka o mieszanym fenotypie immunofenotyp leczenie Keywords: Biphenotypic acute leukemia Mixed phenotype acute leukemia Immunophenotype Treatment a b s t r a c t In 2009, the World Health Organization has published an updated classification of proliferative diseases, whereby biphenotypic acute leukemia and acute bilineal leukemia,which previously were two separate diseases, were replaced by a single name, mixed phenotype acute leukemia (MPAL). Incidence of MPAL is not exactly known and varies in different publications from 0.5 to 5% of all leukemias in children. In these patients genetic disorders are particularly important for both diagnosis and prognosis. However, due to the still unsatisfactory outcome, the main problem remains optimal therapeutic strategy of patients with MPAL. The majority of research points to better outcomes of MPAL treatment with usage of therapeutic programs for the treatment of acute lymphoblastic leukemia (ALL), although the results are worse than in patients with ALL. An attempt to standardize the therapeutic approach and further improve is the project iBFM AMBI2012.

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Prognosis of children with mixed phenotype acute leukemia treated on the basis of consistent immunophenotypic criteria

Cited by 61 publications

References 56 publications

Diagnosis and management of acute myeloid leukemia in children and adolescents: recommendations from an international expert panel

Diagnosis and management of acute myeloid leukemia in children and adolescents: recommendations from an international expert panel

History of treatment and long-term outcome in children with acute lymphoblastic leukemia in the Czech Republic

Ostra białaczka o mieszanym fenotypie – jak rozpoznać, jak leczyć?

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