T-cell acute lymphoblastic leukemia in adults: clinical features, immunophenotype, cytogenetics, and outcome from the large randomized prospective trial (UKALL XII/ECOG 2993).

Journal article

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.

Authors: Marks, D; Paietta, E; Moorman, A; Richards, S; Buck, G

• Publication status: Published
• Journal: Blood
• Volume: 114
• Issue: 25
• Pages: 5136-5145
• Publication date: 2009-12-01
• DOI: 10.1182/blood-2009-08-231217
• EISSN: 1528-0020
• ISSN: 0006-4971
• Language: English
• Keywords: Precursor Cell Lymphoblastic Leukemia-Lymphoma; Male; Cytogenetic Analysis; Humans; Stem Cell Transplantation; Fusion Proteins, bcr-abl; Middle Aged; In Situ Hybridization, Fluorescence; Treatment Outcome; Antineoplastic Combined Chemotherapy Protocols; Immunophenotyping; Transplantation, Homologous; T-Lymphocytes; Female; Adult; Remission Induction; Survival Analysis; Prospective Studies; Young Adult