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Annals of Hematology
Published in: Annals of Hematology 6/2013

01-06-2013 | Original Article

Acute leukemias of ambiguous lineage in adults: molecular and clinical characterization

Authors: Sandra Heesch, Martin Neumann, Stefan Schwartz, Isabelle Bartram, Cornelia Schlee, Thomas Burmeister, Matthias Hänel, Arnold Ganser, Michael Heuser, Clemens-Martin Wendtner, Wolfgang E. Berdel, Nicola Gökbuget, Dieter Hoelzer, Wolf-Karsten Hofmann, Eckhard Thiel, Claudia D. Baldus

Published in: Annals of Hematology | Issue 6/2013

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Abstract

Acute leukemias of ambiguous lineage represent a heterogeneous group of rare, poorly characterized leukemias with adverse outcome. No larger studies have yet performed a combined approach of molecular and clinical characterization of acute undifferentiated leukemia (AUL) and biphenotypic acute leukemia (BAL) in adults. Here we describe 16 adults with AUL and 26 with BAL and performed mutational as well as expression studies of genes with prognostic impact in acute leukemia (BAALC, ERG, MN1, WT1, and IGFBP7). AUL showed overexpression of these genes compared to T-lymphoblastic leukemia (T-ALL), B-precursor ALL, and to acute myeloid leukemia (AML). Genotype alterations were not detectable in AUL. BAL samples were characterized by frequent WT1 mutations (18 %) and BCR-ABL translocations (30 %). ALL-based treatment protocols induced complete remissions in 40 % and AML-like therapies in 22 % of AUL/BAL patients. The outcome in both groups was very poor; a long-term survival was only observed in patients undergoing allogeneic stem cell transplantation (SCT). Our findings indicate that AUL and BAL share important molecular and high-risk features of both myeloid and lymphoid leukemias. BAL patients exhibited genetic alterations, which can be targeted therapeutically. Importantly, ALL therapy might be more effective than AML protocols and AUL/BAL patients should be considered for allogeneic SCT.
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Metadata
Title
Acute leukemias of ambiguous lineage in adults: molecular and clinical characterization
Authors
Sandra Heesch
Martin Neumann
Stefan Schwartz
Isabelle Bartram
Cornelia Schlee
Thomas Burmeister
Matthias Hänel
Arnold Ganser
Michael Heuser
Clemens-Martin Wendtner
Wolfgang E. Berdel
Nicola Gökbuget
Dieter Hoelzer
Wolf-Karsten Hofmann
Eckhard Thiel
Claudia D. Baldus
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Annals of Hematology / Issue 6/2013
Print ISSN: 0939-5555
Electronic ISSN: 1432-0584
DOI
https://doi.org/10.1007/s00277-013-1694-4

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