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A study at Children’s Hospital Los Angeles is shedding new light on the best therapeutic approach for a rare and aggressive leukemia called mixed phenotype acute leukemia (MPAL).

The study–a quantitative synthesis of 20 years of scientific literature–found that starting MPAL treatment with a less-toxic regimen is associated with clear benefits for achieving remission and possibly for long-term survival. The findings were published online in the journal Leukemia on February 27, 2018.

MPAL accounts for 2 to 5 percent of leukemia cases and has been historically difficult to treat, with five-year survival rates of less than 50 percent. The disease affects both children and adults and contains characteristics of two more-common forms of leukemia: acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).

Physicians must decide whether to treat patients with therapy for ALL or therapy for AML, or a hybrid of both approaches. The problem: There’s no clear consensus on which approach is best.

“Because this disease is so rare, we haven’t had clinical trials with thousands of patients to define the optimal therapy,” says Etan Orgel, MD, MS, a specialist in MPAL and a physician in the Center for Cancer and Blood Diseases at Children’s Hospital Los

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