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The clinical characteristics, therapy and outcome of 85 adults with acute lymphoblastic leukemia and t(4;11)(q21;q23)/MLL-AFF1 prospectively treated in the UKALLXII/ECOG2993 trial

Lookup NU author(s): Professor Anthony MoormanORCiD, Dr Lucy Chilton, Dr Amir Enshaei, Professor Christine Harrison FRCPath FMedSci

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Abstract

The biology and outcome of adult t(4;11)(q21;q23)/MLL-AFF1 acute lymphoblastic leukemia are poorly understood. We describe the outcome and delineate prognostic factors and optimal post-remission therapy in 85 consecutive patients (median age 38 years) treated uniformly in the prospective trial UKALLXII/ECOG2993. The immunophenotype of this leukemia was pro-B (CD10(NEG)). Immaturity was further suggested by high expression of the stem-cell antigens, CD133 and CD135, although CD34 expression was significantly lower than in t(4; 11)negative patients. Complete remission was achieved in 77 (93%) patients but only 35% survived 5 years (95% CI: 25-45%); the relapse rate was 45% (95% CI: 33-58%). Thirty-one patients underwent allogeneic transplantation in first remission (15 sibling donors and 16 unrelated donors): with 5-year survival rates of 56% and 67% respectively, only 2/31 patients relapsed. This compares with a 24% survival rate and 59% relapse rate in 46 patients who received post-remission chemotherapy. A major determinant of outcome was age with 71% of patients aged <25 years surviving. Younger patients had lower relapse rates (19%) but most received allografts in first complete remission. In conclusion, multivariate analysis did not demonstrate an advantage of allografting over chemotherapy but only five younger patients received chemotherapy. Prospective trials are required to determine whether poor outcomes in older patients can be improved by reduced-intensity conditioning allografts. NCT00002514 www.clinicaltrials.gov


Publication metadata

Author(s): Marks DI, Moorman AV, Chilton L, Paietta E, Enshaie A, DeWald G, Harrison CJ, Fielding AK, Foroni L, Goldstone AH, Litzow MR, Luger SM, McMillan AK, Racevskis J, Rowe JM, Tallman MS, Wiernik P, Lazarus HM

Publication type: Article

Publication status: Published

Journal: Haematologica

Year: 2013

Volume: 98

Issue: 6

Pages: 945-952

Print publication date: 01/06/2013

Acceptance date: 11/01/2013

ISSN (print): 0390-6078

Publisher: Ferrata Storti Foundation

URL: http://dx.doi.org/10.3324/haematol.2012.081877

DOI: 10.3324/haematol.2012.081877


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Funding

Funder referenceFunder name
G8223452MRC
Department of Health and Human Services
Leukemia & Lymphoma Research
CA13650Public Health Service Grants, National Cancer Institute, National Institutes of Health
CA66636Public Health Service Grants, National Cancer Institute, National Institutes of Health
CA14548Public Health Service Grants, National Cancer Institute, National Institutes of Health
CA14588Public Health Service Grants, National Cancer Institute, National Institutes of Health
CA14958Public Health Service Grants, National Cancer Institute, National Institutes of Health
CA17145Public Health Service Grants, National Cancer Institute, National Institutes of Health
CA21115Public Health Service Grants, National Cancer Institute, National Institutes of Health
CA23318Public Health Service Grants, National Cancer Institute, National Institutes of Health

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