Two Elderly Patients with Philadelphia Chromosome Positive Mixed Phenotype Acute Leukemia Who Were Successfully Treated with Dasatinib and Prednisolone

Abstract

Philadelphia chromosome positive (Ph+) mixed phenotype acute leukemia (MPAL) is a rare type of acute leukemia having both myeloid and lymphoid features for which no optimal treatment has yet been established. We herein describe two elderly Ph+MPAL patients who achieved molecular remission without any serious adverse events by treatment with dasatinib and prednisolone. Although dasatinib induction therapy combined with prednisolone is known to be a highly effective treatment for Ph+ acute lymphoblastic leukemia, its efficacy for Ph+MPAL has not been shown. The clinical courses of the present cases suggest that combination therapy with dasatinib and prednisolone is a safe and effective therapeutic modality in elderly Ph+ MPAL patients.

Mixed-phenotype acute leukemia: state-of-the-art of the diagnosis, classification and treatment

“…Similarly to Ph1+ ALL complete molecular remissions can be achieved even in elderly MPAL patients with only a combination of prednisolone and TKI (ref. [28][29][30]33 ). The presence of FLT3/ITD in MPAL can be a potential therapy target for inhibitors similarly to AML (ref.…”

Efficacy and safety of low‐dose imatinib in an elderly patient with mixed phenotype acute leukemia with t(9;22)(q34;q11.2);BCR‐ABL1

“…The third case was a 69‐year‐old woman with a 15‐year history of type 2 DM, whereas the fourth case was a 69‐year‐old woman who was diagnosed with breast cancer 17 years earlier and was treated with surgery, systemic chemotherapy, and hormonal therapy. The last two patients were treated with dasatinib (140 mg/day) and prednisolone and maintained molecular CR for 16 and 7 months, respectively 9 …”

“…Our review of the literature of relevant cases identified only four reports of elderly patients diagnosed with Ph+MPAL, according to the 2016 WHO classification (Table 1). [7][8][9] These cases were treated with secondgeneration TKIs; however, none of the studies involved patients treated with only imatinib. The first of the reported four cases was a 71-year-old woman with hypertension who was initially treated with imatinib (400 mg/day) and later developed edema and fatigue; therefore, the imatinib dose was reduced to 300 mg/day.…”

Efficacy and safety of low-dose imatinib in an elderly patient with mixed phenotype acute leukemia with t(9;22)(q34;q11.2);BCR-ABL1

“…Our review of the literature of relevant cases identified only four reports of elderly patients who were diagnosed with Ph+ MPAL according to the 2016 WHO classification (Table ). [7][8][9] These cases were treated with secondgeneration TKIs; however, none of the studies involved patients treated with only imatinib. The first of the reported four cases was a 71-year-old female with hypertension who was initially treated with imatinib (400 mg/day) and later developed edema and fatigue; therefore, the imatinib dose was reduced to 300 mg/day.…”