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Blood, 15 December 2004, Vol. 104, No. 13, pp. 4173-4180.
Prepublished online as a Blood First Edition Paper on March 30, 2004; DOI 10.1182/blood-2003-11-3944.
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NEOPLASIA
Age-related phenotypic and oncogenic differences in T-cell acute lymphoblastic leukemias may reflect thymic atrophy
Vahid Asnafi,
Kheira Beldjord,
Marta Libura,
Patrick Villarese,
Corrine Millien,
Paola Ballerini,
Emilienne Kuhlein,
Marina Lafage-Pochitaloff,
Eric Delabesse,
Olivier Bernard, and
Elizabeth Macintyre
From the Necker-Enfants-Malades and Trousseau, Assistance Publique-Hopitaux de Paris (AP-HP), INSERM EMIU210 and Université Paris V, Hôpital Purpan, Toulouse, France; and Institut Paoli Calmettes, Université de la Méditerranée, Marseille, France.
Postnatal thymic involution occurs progressively throughout the first 3 decades of life. It predominantly affects T-cell receptor (TCR)  -lineage precursors, with a consequent proportional increase in multipotent thymic precursors. We show that T-acute lymphoblastic leukemias (T-ALLs) demonstrate a similar shift with age from predominantly TCR expressing to an immature (IM0/ / ) stage of maturation arrest. Half demonstrate HOX11, HOX11L2, SIL-TAL1, or CALM-AF10 deregulation, with each being associated with a specific, age-independent stage of maturation arrest. HOX11 and SIL-TAL represent  -lineage oncogenes, whereas HOX11L2 expression identifies an intermediate  / -lineage stage of maturation arrest. In keeping with preferential  -lineage involution, the incidence of SIL-TAL1 and HOX11L2 deregulation decreased with age. In contrast, HOX11 deregulation became more frequent, suggesting longer latency. TAL1/LMO1 deregulation is more frequent in  -lineage T-ALL, when it is predominantly due to SIL-TAL1 rearrangements in children but to currently unknown mechanisms in adolescents and adults. LMO2 was more frequently coexpressed with LYL1, predominantly in IM0/ / adult cases, than with TAL1. These age-related changes in phenotype and oncogenic pathways probably reflect progressive changes in the thymic population at risk of malignant transformation.

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