T-cell acute lymphoblastic leukemia in adults: clinical features, immunophenotype, cytogenetics, and outcome from the large randomized prospective trial (UKALL XII/ECOG 2993).
The biology and outcome of adult T-cell acute lymphoblastic leukemia are poorly understood. We present here the clinical and biologic features of 356 patients treated uniformly on the prospective trial (UKALL XII/ECOG 2993) with the aim of describing the outcome and identifying prognostic factors. Complete remission was obtained in 94% of patients, and 48% survived 5 years. Positivity of blasts for CD1a and lack of expression of CD13 were associated with better survival (P = .01 and < .001, respectively). NOTCH1 and CDKN2A mutations were seen in 61% and 42% of those tested. Complex cytogenetic abnormalities were associated with poorer survival (19% vs 51% at 5 years, P = .006). Central nervous system involvement at diagnosis did not affect survival (47% vs 48%, P = not significant). For 99 patients randomized between autograft and chemotherapy, 5-year survival was 51% in each arm. Patients with a matched sibling donor had superior 5-year survival to those without donors (61% vs 46%, chi(2), P = .02); this was the result of less relapse (25% vs 51% at 5 years, P < .001). Only 8 of 123 relapsed patients survive. This study provides a baseline for trials of new drugs, such as nelarabine, and may allow risk-adapted therapy in patients with poor-prognosis T-cell ALL.
Marks
David I
DI
Adult Bone Marrow Transplant Unit, University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom. David.Marks@ubht.nhs.uk
Paietta
Elisabeth M
EM
Moorman
Anthony V
AV
Richards
Susan M
SM
Buck
Georgina
G
DeWald
Gordon
G
Ferrando
Adolfo
A
Fielding
Adele K
AK
Goldstone
Anthony H
AH
Ketterling
Rhett P
RP
Litzow
Mark R
MR
Luger
Selina M
SM
McMillan
Andrew K
AK
Mansour
Marc R
MR
Rowe
Jacob M
JM
Tallman
Martin S
MS
Lazarus
Hillard M
HM
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D020732:Cytogenetic Analysis; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D006801:Humans; D016130:Immunophenotyping; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D012074:Remission Induction; D033581:Stem Cell Transplantation / Q000379:methods*; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
D016044:Fusion Proteins, bcr-abl