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<p>Limited data is available on outcomes of mixed phenotype acute leukemia (MPAL) following allogeneic stem cell transplantation (HCT), and the impact of haploidentical HCT with post-transplant cyclophosphamide in this setting is lacking. We retrospectively analyzed 195 adults with MPAL undergoing HCT in first complete remission from 2014 to 2023. The 2-year overall survival (OS) and leukemia free survival (LFS) were 70.7% and 56.4%. Relapse incidence (RI) was 29.8% and non-relapse mortality was 13.8% at 2 years. The cumulative incidence of grade II-IV and III-IV acute graft versus host disease (GvHD) was 28.8% and 9.3% at 100 days. The 2-year cumulative incidence of chronic GvHD was 36.6%. The 2-year GvHD-free-relapse free survival was 37.6% (95%CI 29.9–45.3%). In multivariate analysis, patients undergoing myeloablative conditioning had better OS (HR 0.5, 95%CI 0.27–0.93, <i>p</i> = 0.03) and LFS (HR 0.49, 95%CI 0.26–0.94, <i>p</i> = 0.03). The use of peripheral blood was associated with better LFS (HR 0.36, 95%CI 0.17–0.76, p = 0.008) and lower RI (HR 0.33, 95%CI 0.12–0.93, <i>p </i>= 0.04). In vivo T-cell depletion was associated with lower incidence of chronic GvHD (HR 0.32, 95%CI 0.17–0.63, <i>p</i> &lt; 0.001). These findings highlight that conditioning intensity, graft source, and T-cell depletion strategies are critical factors in optimizing transplant outcomes for MPAL.</p>

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Outcomes of mixed phenotype acute leukemia undergoing allogeneic stem cell transplantation: a retrospective study of the ALWP of EBMT

  • 期刊论文

  • 发表日期：

    2026年5月27日

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  • Annalisa Paviglianiti,
  • Maud Ngoya,
  • Regis Peffault de la Tour,
  • Thomas Schroeder,
  • Peter Remenyi,
  • Linde Morsink,
  • Jaime Sanz,
  • Ladislav Sopko,
  • Francis Ayuk,
  • Mareike Verbeek,
  • Mareike Durholt,
  • Tessa Kerre,
  • Matthias Eder,
  • Pavel Zak,
  • Ibrahim Yakoubagha,
  • Pascal Turlure,
  • Mieke W. H. Roeven,
  • Alexander Kulagin,
  • Alessandro Maggi,
  • Ron Ram,
  • Alessandro Busca,
  • Werner Rabitsch,
  • Dominik Schneidawind,
  • Eolia Brissot,
  • Fabio Ciceri

摘要

Limited data is available on outcomes of mixed phenotype acute leukemia (MPAL) following allogeneic stem cell transplantation (HCT), and the impact of haploidentical HCT with post-transplant cyclophosphamide in this setting is lacking. We retrospectively analyzed 195 adults with MPAL undergoing HCT in first complete remission from 2014 to 2023. The 2-year overall survival (OS) and leukemia free survival (LFS) were 70.7% and 56.4%. Relapse incidence (RI) was 29.8% and non-relapse mortality was 13.8% at 2 years. The cumulative incidence of grade II-IV and III-IV acute graft versus host disease (GvHD) was 28.8% and 9.3% at 100 days. The 2-year cumulative incidence of chronic GvHD was 36.6%. The 2-year GvHD-free-relapse free survival was 37.6% (95%CI 29.9–45.3%). In multivariate analysis, patients undergoing myeloablative conditioning had better OS (HR 0.5, 95%CI 0.27–0.93, p = 0.03) and LFS (HR 0.49, 95%CI 0.26–0.94, p = 0.03). The use of peripheral blood was associated with better LFS (HR 0.36, 95%CI 0.17–0.76, p = 0.008) and lower RI (HR 0.33, 95%CI 0.12–0.93, p = 0.04). In vivo T-cell depletion was associated with lower incidence of chronic GvHD (HR 0.32, 95%CI 0.17–0.63, p < 0.001). These findings highlight that conditioning intensity, graft source, and T-cell depletion strategies are critical factors in optimizing transplant outcomes for MPAL.