title: High prevalence of BCR-ABL fusion transcripts with poor prognostic impact among adult ALL patients: report from Pakistan.
abstract: OBJECTIVE
  Philadelphia (Ph) chromosome positive acute lymphoblastic leukemia (ALL) is a common cytogenetic abnormality associated with poor outcome in adults. This preliminary study, in the absence of substantial evidence, reported the prevalence of the BCR-ABL gene fusion in ALL patients by RT-PCR in Pakistan. Moreover, the prognostic significance of BCR-ABL fusion along with other characteristics was also ascertained.
  
  
  METHODS
  One hundred forty six newly diagnosed ALL patients treated at our center between 2005 and 2008 comprised the study group. The patients were treated with a Children and Leukemia Group B induction regimen.
  
  
  RESULTS
  Among these patients, BCR-ABL fusion oncogene was present in 43 of 78 patients (55%). A statistically significant difference in BCR-ABL-positivity within three age groups (<20 years, 20-50 years, >50 years) was observed (P= 0.001). The median age was significantly higher in the BCR-ABL+ group (30 vs 19 years; P= 0.001). BCR-ABL+ patients were also characterized by higher median WBC counts (96,000/µL vs 23,000//µL, P= 0.002). Complete remission was achieved in 74% BCR-ABL- patients and 35% BCR-ABL+ patients (P= 0.001). Only 10% of BCR-ABL- patients achieved continued complete remission (CR). None of the BCR-ABL+ patients maintained a CR further to induction therapy. With the available therapeutic protocol, the presence of a BCR-ABL fusion predicted a lower survival (P= 0.001).
  
  
  CONCLUSIONS
  A high prevalence of BCR-ABL gene fusion was observed that appeared as a poor prognostic factor. Identification of this genetic entity at diagnosis is crucial for understanding the nature of adult ALL and for deciding optimal treatment.
authors.affiliation: Clinical Pathology, Institute of Nuclear Medicine and Oncology, New Campus Road, Lahore, Pakistan. faiz_mf@hotmail.com
authors.forename: Mariam
authors.initials: M
authors.lastname: Faiz
authors.forename: Qazi Javed
authors.initials: QJ
authors.lastname: Iqbal
authors.forename: Asif
authors.initials: A
authors.lastname: Qureshi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002892:Chromosomes, Human, Pair 22 / Q000235:genetics; D002899:Chromosomes, Human, Pair 9 / Q000235:genetics; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology / Q000235:genetics* / Q000628:therapy*; D015995:Prevalence; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D015996:Survival Rate; D014178:Translocation, Genetic / Q000235:genetics; D055815:Young Adult
chemical_list: D016044:Fusion Proteins, bcr-abl