Tow/Haul mode in our original OEM 5R110 tranny (Ford 5-speed TorqShift) since day-one resulted in a bit rough/jerky shifts, so I minimized use of Tow/Haul mode to keep things smooth. I ran our Class C at 55-60 MPH highway speeds up all kinds of highway grades at all altitudes and just rev'd the V10 well up into the 4000's whenever needed to do it.
HOWEVER, our OEM 5R110 tranny gave up the ghost big-time at only a little above 61K miles. Neither of our two excellent mechanics could understand why (the tranny fluid was still a healthy pink color) an under-loaded E450 chassis blew it's transmission at that low of a mileage regardless of how I had driven it.
I had them replace it with a remanufactured heavy duty version of the 5R110 transmission. This 5R110 transmission, for some reasion, upshifts and downshifts smooth as butter when in Tow/Haul mode, so I now drive it almost exclusivelly in Tow/Haul mode - hoping that this tranny will now last "forever" regardless of what RPMs I run the V10 at. :S
(I hope that what I said above won't discourage V10 owners from tapping into the V10's total capabilities via it's high RPM range ... as I think that my original OEM transmission blew due to a manufacturing defect or my non-use of Tow/Haul mode regardless of engine RPM ... thus overheating the transmission too much from excessive torque converter slippage pulling up long grades in hot weather.)