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Blood, 15 April 2005, Vol. 105, No. 8, pp. 3072-3078.
Prepublished online as a Blood First Edition Paper on January 6, 2005; DOI 10.1182/blood-2004-09-3666.
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Submitted September 24, 2004
Accepted December 30, 2004
Impact of TCR status and genotype on outcome in adult T acute lymphoblastic leukemia: a LALA-94 study
Vahid Asnafi, Agnes Buzyn, Xavier Thomas, Francoise Huguet, Norbert Vey, Jean-Michel Boiron, Oumedaly Reman, Jean-Michel Cayuela, Veronique Lheritier, Jean-Paul Vernant, Denis Fiere, Elizabeth Macintyre, and Herve Dombret*
Hematology, Necker-Enfants-Malades, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France; INSERM EMIU210, Paris, France
Hematology, Necker-Enfants-Malades, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France
Hopital Edouard Herriot, Lyon, France
Hopital Purpan, Toulouse, France
Institut Paoli Calmettes, Marseille, France
Hopital du Haut Leveque, Bordeaux, France
Centre Hospitalier Universitaire, Caen, France
Saint Louis, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France
Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France
* Corresponding author; email: herve.dombret{at}sls.ap-hop-paris.fr.
T-ALLs within the LALA-94 prospective trial were treated with a 4 drugs / 4 week induction, with intermediate dose cytarabine and mitoxantrone salvage for patients not achieving complete remission (CR) in one course. Only the latter were allografted, if possible, thus providing an informative setting for assessing early response. 91 representative T-ALLs were classified into surface TCR expressing T-ALLs (TCR + or TCR +), pre- T-ALLs (cTCR +, TCR-) and immature (IM) cTCRb-, TCR- T-ALLs; 81 underwent genotyping for SIL-TAL1, CALM-AF10, HOX11 and HOX11L2.
Overall, CR was obtained in 81 patients (89%); relapse rate was 62% at 4 years and overall survival (OS) 38%. CR rate was significantly lower in IM T-ALLs after 1 course (45% vs. 87%; p< 0.001) and after salvage (74% vs. 97%; p=0.002), with the latter inducing a higher rate of CR (9/14; 64%) than initial induction. Once CR was obtained, cumulative relapse rates were similar for IM, pre- and TCR+ T-ALLs (p=0.51) but were higher in HOX11L2 (83%) and SIL-TAL1 (82%) T-ALLs compared to other genetic subgroups (48%; p=0.05). This was associated with an inferior OS for HOX11L2 T-ALLs (13% vs. 47% in HOX11L2- T-ALLs, p=0.009). The majority of HOX11 T-ALLs underwent allografting, predominantly in second CR, but were not associated with a superior OS. Both TCR and genotypic stratification can therefore contribute to risk adapted management of adult T-ALLs.

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