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Blood, 15 January 2006, Vol. 107, No. 2, pp. 473-479.
Prepublished online as a Blood First Edition Paper on September 22, 2005; DOI 10.1182/blood-2005-04-1754.
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CLINICAL TRIALS AND OBSERVATIONS
Adult T-cell acute lymphoblastic leukemia: biologic profile at presentation and correlation with response to induction treatment in patients enrolled in the GIMEMA LAL 0496 protocol
Antonella Vitale,
Anna Guarini,
Cristina Ariola,
Marco Mancini,
Cristina Mecucci,
Antonio Cuneo,
Fabrizio Pane,
Giuseppe Saglio,
Giuseppe Cimino,
Agostino Tafuri,
Giovanna Meloni,
Francesco Fabbiano,
Anna Recchia,
Maria Grazia Kropp,
Mauro Krampera,
Nicola Cascavilla,
Felicetto Ferrara,
Antonio Romano,
Patrizio Mazza,
Claudio Fozza,
Francesca Paoloni,
Marco Vignetti, and
Robin Foà
From the Department of Cellular Biotechnologies and Hematology, University "La Sapienza" Roma, Rome; Hematology and Bone Marrow Transplantation Unit, University of Perugia, Perugia; Department of Biomedical Sciences and Advanced Therapy, University of Ferrara, Ferrara; CEINGE Biotecnologie Avanzate, Department of Biochemistry and Medical Biotechnology, Federico II University, Naples; Department of Clinical and Biological Sciences, S. L. Gonzaga Hospital, Orbassano, University of Turin, Turin; Hematology, Hospital Cervello, Palermo; Hematology, Civil Hospital, Pescara; Hematology, Azienda Ospedaliera A. Pugliese, Catanzaro; Department of Clinical and Experimental Medicine, University of Verona, Verona; Hematology, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo; Hematology, Cardarelli Hospital, Naples; Ospedale Regionale "A. Di Summa," Brindisi; Ospedale S. S. Annunziata, Taranto; University of Sassari, Sassari; and Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA) Data Center, Rome, Italy.
Between 1996 and 2000, 90 newly diagnosed adult patients with T-acute lymphoblastic leukemia (T-ALL) were registered in the Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA) Leucemia Acuta Limfoide (LAL) 0496 protocol. Cases were centrally processed for morphology, immunophenotype, cytogenetics, molecular biology, and multidrug resistance (MDR). Twenty-two patients were females and 68 were males. Four percent of cases were pro-T, 47% pre-T, 39% cortical T, and 10% mature T-ALL. Fifty-six percent of patients with pro-T + pre–T-ALL achieved complete remission (CR) compared with 91% for cortical + mature cases (P = .002). CD34 expression was associated with a significantly lower CR rate: 54% versus 84% (P = .009). Thirty-one (36.5%) of 85 patients had an abnormal karyotype, the most common abnormality (15%) being a partial del(6q). The cytogenetic profile did not impact on CR achievement. MDR1 function, present in 26% of cases, correlated significantly with CR achievement (P = .004). A highly significant (P = .001) difference in CR rate was observed between patients who did not express the CD13/CD33/CD34 antigens and were MDR functionally negative (96%) compared with patients positive for at least one of these markers (57%). Multivariate analysis showed an impact on CR achievement for CD33 expression and MDR1 function. An extensive biologic workup of adult T-ALL cases at presentation is recommended in order to design tailored therapeutic strategies aimed at improving CR rates.
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