title: Good Outcome for Very High Risk Adult B-cell Acute Lymphoblastic Leukaemia Carrying Genetic Abnormalities t(4;11)(q21;q23) or t(9;22)(q34;q11), if Promptly Submitted to Allogeneic Transplantation, after Obtaining a Good Molecular Remission.
abstract: OBJECTIVE
  Acute lymphoblastic leukaemia (ALL) carrying t(9;22) or t(4;11) genetic abnormalities represents a very high risk subtype of disease (VHR-ALL). Hematopoietic stem cell transplantation (HSCT) remains the best curative option not only for t(4;11) ALL, but also for t(9;22) ALL in the tyrosin-kinase inhibitors era. In the last years, low molecular level of minimal residual disease (MRD) before HSCT was reported as one of the best favourable indexes for survival in ALL. Here we observed that even these patients can show a favourable outcome if submitted to HSCT with very low MRD.
  
  
  METHODS
  We considered 18 consecutive VHR-ALL patients eligible to HSCT. 16 of them were transplanted in first remission, as soon as possible, employing myelo-ablative conditioning regimens. Molecular MRD has been evaluated before and after HSCT.
  
  
  RESULTS
  Immediately before HSCT, MRD revealed: complete molecular remission (MRD(neg)) for five patients, and a level <1×10(-3) for seven patients. 100 days after HSCT we had: MRD(neg) for seven patients and a decrease for all the others after HSCT. After the tapering of immunosuppressive drugs, 13 patients reached the MRD(neg) in a median time of 8 months (range 3-16). In the intention to treat analysis, 14/18 patients are alive and disease free at the date of analysis. Overall survival and event free survival is of 78% and 66% respectively, with an average follow-up of 45 months (range 6-84) since HSCT.
  
  
  CONCLUSIONS
  Early transplantation with low MRD level seems to be correlated with a favourable outcome also in VHR-ALL.
authors.affiliation: Haematology Division and BMT Unit, Ospedale San Gerardo, Monza, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Parma
authors.affiliation: Haematology Division and BMT Unit, Ospedale San Gerardo, Monza, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Viganò
authors.affiliation: Haematology Division and BMT Unit, Ospedale San Gerardo, Monza, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Fumagalli
authors.affiliation: Centro Ricerca Tettamanti, Clinica Pediatrica Università di Milano Bicocca, Ospedale San Gerardo/Fondazione MBBM, Monza, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Colnaghi
authors.affiliation: Centro Ricerca Tettamanti, Clinica Pediatrica Università di Milano Bicocca, Ospedale San Gerardo/Fondazione MBBM, Monza, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Centro Ricerca Tettamanti, Clinica Pediatrica Università di Milano Bicocca, Ospedale San Gerardo/Fondazione MBBM, Monza, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Mottadelli
authors.affiliation: Centro Ricerca Tettamanti, Clinica Pediatrica Università di Milano Bicocca, Ospedale San Gerardo/Fondazione MBBM, Monza, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rossi
authors.affiliation: Haematology Division and BMT Unit, Ospedale San Gerardo, Monza, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Elli
authors.affiliation: Haematology Division and BMT Unit, Ospedale San Gerardo, Monza, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Terruzzi
authors.affiliation: Haematology Division and BMT Unit, Ospedale San Gerardo, Monza, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Belotti
authors.affiliation: Centro Ricerca Tettamanti, Clinica Pediatrica Università di Milano Bicocca, Ospedale San Gerardo/Fondazione MBBM, Monza, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cazzaniga
authors.affiliation: Dipartimento di Scienze della Salute, Università di Milano Bicocca.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Pogliani
authors.affiliation: Haematology Division and BMT Unit, Ospedale San Gerardo, Monza, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Pioltelli