title: Stem cell transplant in the treatment of childhood biphenotypic acute leukemia.
abstract: BACKGROUND
  Many studies have found that biphenotypic acute leukemia (BAL) is associated with a poor outcome.
  
  
  METHODS
  We retrospectively reviewed the medical records and analyzed clinicopathological data on 25 children with BAL, and correlated outcomes with prognostic factors.
  
  
  RESULTS
  BAL constituted 4.4% of all acute childhood leukemia cases. In terms of immunophenotype, 14 patients had leukemia with myeloid plus B-lymphoid (M + B) marker, 7 with myeloid plus T-lymphoid (M + T) marker, and 4 with myeloid plus B-lymphoid and T-lymphoid (M + B + T) markers. Overall survival was superior in patients with the M + B immunophenotype (P = 0.004). Hematopoietic stem cell transplantation (HSCT) did not improve either overall survival or event-free survival compared to chemotherapy alone (hazard ratio 0.98, 95% CI 0.35-2.76, P = 0.966; hazard ratio 1.07, 95% CI 0.41-2.78, P = 0.88). Each of four patients with high-hyperdiploidy (>50 chromosomes) displayed a good treatment response and long-term overall survival even though these patients were treated with chemotherapy alone.
  
  
  CONCLUSIONS
  Treatment outcomes in childhood BAL patients differed by immunophenotype and cytogenetics. HSCT did not offer a significantly greater survival advantage compared to chemotherapy. While these data suggest that treatment should be individualized and stratified according to biologic characteristics and prognostic factors in BAL, prospective trial data are still needed.
authors.affiliation: Department of Pediatric Hematology and Oncology, Asan Medical Center, Seoul, Korea.
authors.forename: Jeong A
authors.initials: JA
authors.lastname: Park
authors.forename: Thad T
authors.initials: TT
authors.lastname: Ghim
authors.forename: Keun wook
authors.initials: Kw
authors.lastname: Bae
authors.forename: Ho Joon
authors.initials: HJ
authors.lastname: Im
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Jang
authors.forename: Chan Jeong
authors.initials: CJ
authors.lastname: Park
authors.forename: Hyun Sook
authors.initials: HS
authors.lastname: Chi
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Seo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D015456:Leukemia, Biphenotypic, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome