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.
© 2026. The Author(s), under exclusive licence to Springer Nature Limited.