title: Mixed-phenotype acute leukemia: suboptimal treatment when the 2008/2016 WHO classification is used.
abstract: BACKGROUND
  Different criteria have been used to diagnose mixed-phenotype acute leukemia (MPAL), which has impacted the number of individuals diagnosed with this pathology. Better outcomes have been reported when using acute lymphoblastic leukemia (ALL)-type chemotherapy in the treatment of MPAL.
  
  
  METHODS
  We compared the outcome of 4 groups of patients with MPAL. Group 1 included patients diagnosed using the 2008/2016 World Health Organization (WHO) classification; group 2 included patients diagnosed using the European Group for the Immunological Characterization of Leukemias (EGIL) criteria; group 3 included patients diagnosed using either the EGIL or the 2008/2016 WHO criteria; and group 4 was comprised of patients diagnosed with MPAL using the EGIL classification only.
  
  
  RESULTS
  We found a significantly worse disease-free survival (groups 1-4) and overall survival (OS) (groups 2 and 3) when comparing MPAL patients to other acute leukemia (AL) patients. A significantly better OS was obtained in patients (groups 2-4) treated with ALL-type chemotherapy compared to acute myeloid leukemia (AML)-type regimens.
  
  
  CONCLUSIONS
  In light of these results, and because a trend (P=0.06) was found with regard to a better OS in group 4 when compared to other AL patients, an argument can be made that the 2008/2016 WHO classification is underpowered to diagnose all MPAL cases, potentially resulting in the suboptimal treatment of some individuals with AL.
authors.affiliation: Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico.; Faculty of Health Sciences, Universidad Anahuac Mexico Norte, Huixquilucan, State of Mexico, Mexico.
authors.forename: Alan
authors.initials: A
authors.lastname: Pomerantz
authors.affiliation: Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico.; Faculty of Health Sciences, Universidad Anahuac Mexico Norte, Huixquilucan, State of Mexico, Mexico.
authors.forename: Sergio
authors.initials: S
authors.lastname: Rodriguez-Rodriguez
authors.affiliation: Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico.
authors.forename: Roberta
authors.initials: R
authors.lastname: Demichelis-Gomez
authors.affiliation: Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico.
authors.forename: Georgina
authors.initials: G
authors.lastname: Barrera-Lumbreras
authors.affiliation: Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico.
authors.forename: Olga
authors.initials: O
authors.lastname: Barrales-Benitez
authors.affiliation: Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico.
authors.forename: Xavier
authors.initials: X
authors.lastname: Lopez-Karpovitch
authors.affiliation: Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Tlalpan, Mexico City, Mexico.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Aguayo-Gonzalez
keywords: EGIL classification; Mixed-phenotype acute leukemia; Suboptimal treatment; WHO classification