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Chromosomal translocations play a unique role in influencing prognosis in
childhood acute lymphoblastic leukemia
DL Williams, J Harber, SB Murphy, AT Look, DK Kalwinsky, G Rivera, SL Melvin, S Stass and GV Dahl
Certain types of chromosomal abnormalities have been shown to exert strong
independent influence on treatment outcome in acute lymphoblastic leukemia
(ALL). To identify the changes most closely associated with prognosis, we
analyzed the completely banded blast cell karyotypes of 161 children with
this disease. One hundred twenty-five cases had one or more chromosomal
abnormalities, with 45 showing translocations. The frequency of
translocations was highest (58%) among patients with pseudodiploid
karyotypes and lowest (0%) in the hyperdiploid group defined by 51 or more
chromosomes. During the maximum 6-year follow-up period, 30 of the 45
patients with a translocation failed therapy, compared with only 27 of the
116 who lacked this feature. Life-table estimates of event-free survival
indicate that only 14% of the translocation group will be in complete
remission at 3 years. The percentages of failures associated with random
and nonrandom translocations were virtually identical (68% v 65%). When
entered in a Cox proportional hazards model with seven other types of
chromosomal abnormalities, and then with 11 clinical and laboratory
variables of known prognostic value in ALL, translocation emerged as the
strongest single predictor of treatment outcome (P less than 0.0001). The
model indicated that translocation increases the risk of treatment failure
six times by comparison with the absence of this feature. These findings
offer an explanation for the majority of early treatment failures in
childhood ALL, including those previously attributed to ploidy
classification.
Volume 68,
Issue 1,
pp. 205-212,
07/01/1986
Copyright © 1986 by The American Society of Hematology
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