Immunophenotypic and genotypic features, clinical characteristics, and treatment outcome of adult pro-B acute lymphoblastic leukemia: Results of the German multicenter trials GMALL 03/87 and 04/89

Item Type:	Article
Title:	Immunophenotypic and genotypic features, clinical characteristics, and treatment outcome of adult pro-B acute lymphoblastic leukemia: Results of the German multicenter trials GMALL 03/87 and 04/89
Creators Name:	Ludwig, W.D. and Rieder, H. and Bartram, C.R. and Heinze, B. and Schwartz, S. and Gassmann, W. and Loeffler, H. and Hossfeld, D. and Heil, G. and Handt, S. and Heyll, A. and Diedrich, H. and Fischer, K. and Weiss, A. and Voelkers, B. and Aydemir, U. and Fonatsch, C. and Goekbuget, N. and Thiel, E. and Hoelzer, D.
Abstract:	In contrast to childhood acute lymphoblastic leukemia (ALL), the cell-biological features, clinical characteristics, and treatment outcome of CD10(-) pro-B ALL have not yet been determined in larger series of adult patients. Therefore, we studied 57 adult patients with newly diagnosed pro-B ALL (median age, 30 years) enrolled in two consecutive German multicenter ALL studies (03/87 and 04/89). Extensive immunophenotypic characterization of leukemic blasts could be performed on all patients, whereas adequate cytogenetic data were available in 33 cases and molecular studies in 18 cases, using reverse transcription-polymerase chain reaction to detect MLL-AF-4 transcripts. Twenty-two patients demonstrated a t(4;11)(q21;q23) and/or MLL-AF-4 rearrangements, and 6 patients had other structural abnormalities, including a t(9;22)(q34;q11) (N = 2). Nine patients had a normal karyotype. Patients with 11q23 abnormalities tended to be younger (median age, 29 years) and were characterized by male predominance (64%), hyperleukocytosis (median leukocyte count, 168 x 10(9)/L), and a frequent coexpression of CD65s (64%) as compared with patients with other cytogenetic abnormalities or a normal karyotype. Twelve of 16 (75%) pro-B ALL patients in study 03/87 and 30 of 41 (73%) in study 04/89 achieved a complete remission (CR). Sixteen of 30 patients in study 04/89 remain in continuous CR (CCR) in contrast to only 2 of 12 patients in study 03/87. Interestingly, all 7 patients treated with high-dose cytarabine and mitoxantrone as consolidation in study 04/89 remain alive and leukemia-free. One patient in study 03/87 and 8 in study 04/89 underwent autologous (N = 2) or allogeneic (N = 7) bone marrow transplantation (BMT). The median remission duration was 420 days for patients in study 03/87 and has not yet been reached in study 04/89. The median survival time of all pro-B ALL patients was 571 days in study 03/87 and 747 days in study 04/89. Among the 22 patients with a t(4;11) and/or MLL-AF-4 rearrangements, 17 achieved a CR and 8 are still in CCR, of whom 4 underwent an allogeneic BMT. Remission duration and overall survival did not differ significantly between pro-B ALL patients with 11q23 abnormalities and those with a normal karyotype or other structural abnormalities. These data indicate that intensification of postremission treatment may improve the prognosis of adult pro-B ALL, including patients with a t(4;11). Copyright 1998 by The American Society of Hematology.
Keywords:	Chromosome Aberrations, Chromosome Disorders, Immunophenotyping, Karyotyping, Precursor B-Cell Lymphoblastic Leukemia-Lymphoma, Remission Induction, Treatment Outcome
Source:	Blood
ISSN:	0006-4971
Publisher:	American Society of Hematology
Volume:	92
Number:	6
Page Range:	1898-1909
Date:	15 September 1998
Official Publication:	http://bloodjournal.hematologylibrary.org/cgi/content/abstract/92/6/1898
PubMed:	View item in PubMed

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