SOHO 2023 | Acute leukemias of ambiguous lineage: biology and treatment approaches
Caner Saygin, MD, University of Chicago, Chicago, IL, discusses acute leukemias of ambiguous lineage (ALAL) and the typical therapeutic approaches used to treat these diseases. Dr Saygin highlights the dependence on retrospective data for treatment decisions due to a lack of clinical trials investigating these rare leukemias. This interview took place at the Eleventh Annual Meeting of the Society of Hematologic Oncology (SOHO 2023) held in Houston, TX.
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Transcript (edited for clarity)
Acute leukemias of ambiguous lineage or mixed phenotype acute leukemias are rare. They represent 3 to 4% of acute leukemias in adults. They are genetically heterogeneous. We see BCR-ABL1 rearrangements or KMT2A rearrangements, but we also see a lot of other mutations that can be shared with acute leukemias of uni-lineage. The difficulty with MPAL is that we don’t have a lot of prospective randomized trials performed in this disease setting, so the treatment decisions are largely based on retrospective data...
Acute leukemias of ambiguous lineage or mixed phenotype acute leukemias are rare. They represent 3 to 4% of acute leukemias in adults. They are genetically heterogeneous. We see BCR-ABL1 rearrangements or KMT2A rearrangements, but we also see a lot of other mutations that can be shared with acute leukemias of uni-lineage. The difficulty with MPAL is that we don’t have a lot of prospective randomized trials performed in this disease setting, so the treatment decisions are largely based on retrospective data. Typically, the first line therapy would be an ALL-type regimen, either pediatric-inspired protocols or reduced intensity regimens for older adults. If these therapies do not work, we might incorporate ALL-type second-line therapies such as inotuzumab or blinatumomab, and then, ultimately, we may have to switch to an AML type regimen. The other important piece is that these patients are encouraged to move forward with allogeneic stem cell transplant when they achieve first complete remission. However, with the emergence of several exciting new drugs, this might not be true in the future. Perhaps some patients may be spared from transplant, but that’s still what we would recommend.
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