{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:16:40Z","timestamp":1791983800966,"version":"4.4.0"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,6,28]],"date-time":"2020-06-28T00:00:00Z","timestamp":1593302400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Mixed phenotype acute leukemia (MPAL) is thought to have poor outcome, and presence of the Philadelphia chromosome (Ph+) has been considered to be an adverse prognostic marker. However, most of these reports were in the pre\u2010tyrosine kinase inhibitors (TKIs) era. Recent limited reports indicate improved outcomes for MPAL with the addition of TKIs. We examined the outcomes of 241 cases of MPAL according to the 2008 WHO classification from the Surveillance, Epidemiology, and End Results registry. The <jats:italic>MLL<\/jats:italic>+ patients had a median age of 6\u2009years while other subtypes occurred mostly in adults and had comparable age. On multivariate analyses and after adjustment for age, year of diagnosis and chemotherapy status, Ph+ MPAL patients had reduced risk of death in comparison to Ph(\u2013) MPAL patients (hazard ratio [HR] =\u20090.28, <jats:italic>P<\/jats:italic> = .002). So, <jats:italic>MLL<\/jats:italic>+ MPAL had the worst outcome with a 10\u2010fold increased risk of death in comparison to Ph+ MPAL patients (HR = 10.2, <jats:italic>P<\/jats:italic> &lt; .001). Importantly, the outcome of Ph+ MPAL was comparable to Ph+ acute lymphoblastic leukemia in a 1:1 matched case\u2010control analysis. In conclusion, this is the largest registry study which examines the outcomes of MPAL subtypes. We confirm that MPAL is a heterogenous disease. Note, Ph+ MPAL nowadays has a better OS in comparison to other subtypes and is comparable to Ph+ ALL patients. This is most likely secondary to changes in practice and more utilization of TKIs. On the other hand, <jats:italic>MLL<\/jats:italic> rearrangement is associated with infantile MPAL and has a dismal prognosis.<\/jats:p>","DOI":"10.1002\/ajh.25873","type":"journal-article","created":{"date-parts":[[2020,5,18]],"date-time":"2020-05-18T06:46:22Z","timestamp":1589784382000},"page":"1015-1021","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Prognostic impact of Philadelphia chromosome in mixed phenotype acute leukemia (<scp>MPAL<\/scp>): A cancer registry analysis on real\u2010world outcome"],"prefix":"10.1002","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2233-6539","authenticated-orcid":false,"given":"Ayman","family":"Qasrawi","sequence":"first","affiliation":[{"name":"Division of Hematology, Blood &amp; Marrow Transplantation University of Kentucky Medical Center, Markey Cancer Center  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reshma","family":"Ramlal","sequence":"additional","affiliation":[{"name":"Division of Hematology, Blood &amp; Marrow Transplantation University of Kentucky Medical Center, Markey Cancer Center  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinhold","family":"Munker","sequence":"additional","affiliation":[{"name":"Division of Hematology, Blood &amp; Marrow Transplantation University of Kentucky Medical Center, Markey Cancer Center  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard C.","family":"Hildebrandt","sequence":"additional","affiliation":[{"name":"Division of Hematology, Blood &amp; Marrow Transplantation University of Kentucky Medical Center, Markey Cancer Center  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2015.03.012"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2010.202"},{"issue":"10","key":"e_1_2_8_4_1","first-page":"1783","article-title":"Proposals for the immunological classification of acute leukemias. 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