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Chromosomal abnormalities identify high-risk and low-risk patients with
acute lymphoblastic leukemia
CD Bloomfield, AI Goldman, G Alimena, R Berger, GH Borgstrom, L Brandt, D Catovsky, A de la Chapelle, GW Dewald and OM Garson
The importance of banded chromosome analyses in predicting long-term
outcome in acute lymphoblastic leukemia (ALL) was evaluated in this
follow-up study of 329 patients from the Third International Workshop on
Chromosomes in Leukemia. Patients were divided into ten groups according to
pretreatment karyotype: no abnormalities, one of the following structural
abnormalities [the Philadelphia chromosome, translocations involving
8q24,t(4;11), 14q+, 6q-] or, in the remaining cases, modal number [less
than 46, 46, 47 to 50, greater than 50]. Achievement and duration of
complete remission (CR) and survival differed among chromosome groups (P
less than .0001). Karyotype was an independent prognostic factor for
duration of first CR and survival, even when age, initial leukocyte count
(WBC), French-American-British (FAB) type, and immunologic phenotype were
considered. Among adults, prolonged remission and survival were uncommon in
all chromosome groups. Only in the normal karyotype group was median
survival even two years. Among children, striking differences in long-term
remission and survival were seen depending upon karyotype. Children in the
greater than 50 group did best, with 70% remaining in first CR for a median
duration in excess of five years. Children in the 47-50, 6q-, and normal
karyotype groups also had prolonged survivals. In contrast, certain
translocations [t(9;22)(q34;q11), t(4;11)(q21;q14-23), t(8;14)(q24;q32)]
identified children who had short survivals, even in the presence of
favorable prognostic factors including a low WBC, L1 morphology, and non-T,
non-B immunologic phenotype. We conclude that chromosome analysis is
required at diagnosis in patients with ALL, and that children with these
specific translocations should be managed as having high-risk ALL.
Volume 67,
Issue 2,
pp. 415-420,
02/01/1986
Copyright © 1986 by The American Society of Hematology
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