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Blood, 1 October 2007, Vol. 110, No. 7, pp. 2324-2330.
Prepublished online as a Blood First Edition Paper on July 3, 2007; DOI 10.1182/blood-2007-04-079988.


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CLINICAL TRIALS AND OBSERVATIONS

Prognostic and oncogenic relevance of TLX1/HOX11 expression level in T-ALLs

Julie Bergeron1, Emmanuelle Clappier2, Isabelle Radford1, Agnès Buzyn3, Corinne Millien1, Gwendoline Soler1, Paola Ballerini4, Xavier Thomas5, Jean Soulier2, Hervé Dombret6, Elizabeth A. Macintyre1, and Vahid Asnafi1

1 The Université Paris V René Descartes, Institut National de la Santé et de la Recherche Médicale (INSERM) EMI0210 and Assistance Publique–Hôpitaux de Paris (AP-HP) Hôpital Necker-Enfants-Malades, Paris; 2 INSERM U728 Unité d'immuno-hématologie (UIH) and Hematology Laboratory AP-HP Hôpital St-Louis, Paris; 3 Hematology Department Hôpital Necker-Enfants-Malades, Paris; 4 Service d'hématologie biologique Hôpital Armand Trousseau, Paris; 5 Department of Hematology Hôpital Edouard Herriot, Lyon; 6 Hematology Department Hôpital St-Louis, Paris, France

TLX1 is a homeodomain transcription factor generally associated with a favorable outcome in T-cell acute lymphoblastic leukemia (T-ALL). However, the molecular mechanisms of TLX1 deregulation remain unclear and various transcript levels in the absence of 10q24 abnormalities have been reported. A reproducible and accurate delineation of TLX1+ T-ALL will be necessary for proper therapeutic stratification. We have studied 264 unselected T-ALLs (171 adults and 93 children) and show that T-ALLs expressing high levels of TLX1 (n = 35, 13%), defined as a real-time quantitative polymerase chain reaction (RQ-PCR) level of TLX1 greater than 1.00 ABL, form a homogeneous oncogenic group, based on their uniform stage of maturation arrest and oncogenetic and transcriptional profiles. Furthermore, TLX1-high T-ALLs harbor molecular TLX1 locus abnormalities in the majority (31/33), a proportion largely underestimated by standard karyotypic screening. T-ALLs expressing TLX1 at lower levels (n = 57, 22%) do not share these characteristics. Prognostic analysis within the adult LALA94 and GRAALL03 prospective protocols demonstrate a better event-free survival (P = .035) and a marked trend for longer overall survival (P = .059) for TLX1-high T-ALLs, while the expression of lower levels of TLX1 does not impact on prognosis. We propose that TLX1+ T-ALLs be defined as cases expressing TLX1/ABL ratios greater than 1 and/or demonstrating TLX1 rearrangement. Therapeutic modification should be considered for those patients.


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