Mixed phenotypic acute leukemia, diagnostic challenges and significance of various prognostic markers - A one year follow up a retrospective cohort study

• Author Details:   
• Tejaswini Gudibande ^*
• Sharat Damodar
• Deepak M B
• Sudarshan Chougule
• Shilpa Prabhu

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Aim: To analyze the clinical and immunophenotypic characteristics of patients diagnosed with Acute Leukemia at the Department of Hematology, Mazumdar Shaw Medical Centre, Narayana Hrudayalaya, Bengaluru, between January 1, 2017, and July 31, 2022, and to determine the prevalence of Mixed Phenotypic Acute Leukemia (MPAL) or Acute Leukemia of Ambiguous Lineage based on WHO and EGIL criteria.

Materials and Methods: A retrospective cohort study was conducted on 542 patients presenting with suspected Acute Leukemia. Flow cytometric analysis using the Acute Leukemia Flow Cytometric Diagnostic panel (ALCD) was performed to assess the immunophenotype features. 88 patients were excluded based on exclusion criteria. The remaining 454 patients were analyzed for demographic characteristics, immunophenotypic features, and survival outcomes.

Results: 1. A total of 454 patients were included in the study: 266 males and 188 females, with a median age of 27 years (range: 0.33 to 80 years); 2. Of the total, 369 patients were newly diagnosed; 3. 21 cases (5.69%) were identified as having features of Acute Leukemia of Ambiguous Lineage (EGIL criteria) or Mixed Phenotypic Acute Leukemia (MPAL) according to WHO criteria; 4. 15 of these cases (71.4%) met the WHO criteria for MPAL; 5. The most common immunophenotype was T/Myeloid (47.6%, n=10); 6. The overall survival (OS) rates were as follows: ● Day 30: 90.5%; ● Day 60: 85.7%; ● Day 90: 85.7%; ● 6 months: ● 71.4%; ● 1 year: 46.8%; 7. The median OS between EGIL-defined and EGIL-WHO populations was comparable.

Conclusion: The study highlights the prevalence of Mixed Phenotypic Acute Leukemia and Acute Leukemia of Ambiguous Lineage in the study population. The overall survival rates indicate a substantial decline over time, and there was no significant difference in survival between patients categorized by EGIL and EGIL-WHO criteria. These findings suggest the importance of early diagnosis and further research into the management and prognosis of ambiguous acute leukemias.