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Blood, 15 April 2007, Vol. 109, No. 8, pp. 3189-3197.
Prepublished online as a Blood First Edition Paper on December 14, 2006; DOI 10.1182/blood-2006-10-051912.
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CLINICAL TRIALS AND OBSERVATIONS
CLINICAL TRIALS AND OBSERVATIONS
Karyotype is an independent prognostic factor in adult acute lymphoblastic leukemia (ALL): analysis of cytogenetic data from patients treated on the Medical Research Council (MRC) UKALLXII/Eastern Cooperative Oncology Group (ECOG) 2993 trial
Anthony V. Moorman1,
Christine J. Harrison1,
Georgina A. N. Buck2,
Sue M. Richards2,
Lorna M. Secker-Walker1,
Mary Martineau1,
Gail H. Vance3,
Athena M. Cherry4,
Rodney R. Higgins5,
Adele K. Fielding6,
Letizia Foroni6,
Elisabeth Paietta7,
Martin S. Tallman8,
Mark R. Litzow9,
Peter H. Wiernik7,
Jacob M. Rowe10,
Anthony H. Goldstone11,
Gordon W. Dewald, on behalf of the Medical Research Council (MRC)/National Cancer Research Institute (NCRI) Adult Leukaemia Working Party of the United Kingdom and the Eastern Cooperative Oncology Group12
1 Leukaemia Research Cytogenetics Group, Cancer Sciences Division, University of Southampton, United Kingdom;
2 Clinical Trial Service Unit, University of Oxford, United Kingdom;
3 Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN;
4 Department of Pathology, Stanford University School of Medicine, Stanford, CA;
5 Allina Medical Laboratories, Abbott Northwestern Hospital, Minneapolis, MN;
6 Department of Haematology, Royal Free and University College Medical School (UCMS), London, United Kingdom;
7 Comprehensive Cancer Center, Our Lady of Mercy Medical Center, New York, NY;
8 Division of Hematology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL;
9 Division of Hematology, Mayo Clinic, Rochester, MN;
10 Department of Hematology, Rambam Medical Center, Haifa, Israel;
11 Department of Haematology, University College London Hospital (UCLH), United Kingdom;
12 Division of Laboratory Genetics, Mayo Clinic, Rochester, MN
Pretreatment cytogenetics is a known predictor of outcome in hematologic malignancies. However, its usefulness in adult acute lymphoblastic leukemia (ALL) is generally limited to the presence of the Philadelphia (Ph) chromosome because of the low incidence of other recurrent abnormalities. We present centrally reviewed cytogenetic data from 1522 adult patients enrolled on the Medical Research Council (MRC) UKALLXII/Eastern Cooperative Oncology Group (ECOG) 2993 trial. The incidence and clinical associations for more than 20 specific chromosomal abnormalities are presented. Patients with a Ph chromosome, t(4;11)(q21;q23), t(8;14)(q24.1;q32), complex karyotype (5 or more chromosomal abnormalities), or low hypodiploidy/near triploidy (Ho-Tr) all had inferior rates of event-free and overall survival when compared with other patients. In contrast, patients with high hyperdiploidy or a del(9p) had a significantly improved outcome. Multivariate analysis demonstrated that the prognostic relevance of t(8;14), complex karyotype, and Ho-Tr was independent of sex, age, white cell count, and T-cell status among Ph-negative patients. The observation that Ho-Tr and, for the first time, karyotype complexity confer an increased risk of treatment failure demonstrates that cytogenetic subgroups other than the Ph chromosome can and should be used to risk stratify adults with ALL in future trials.

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