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Case-control study suggests a favorable impact of TEL rearrangement in
patients with B-lineage acute lymphoblastic leukemia treated with
antimetabolite-based therapy: a Pediatric Oncology Group study
JE Rubnitz, JJ Shuster, VJ Land, MP Link, DJ Pullen, BM Camitta, CH Pui, JR Downing and FG Behm
St Jude Children's Research Hospital, Memphis, TN 38105, USA.
TEL gene rearrangement is the most common genetic lesion in pediatric acute
lymphoblastic leukemia (ALL), occurring in about 25% of B-lineage cases. We
previously showed that, among patients treated on St Jude protocols, TEL
rearrangement independently conferred an excellent prognosis. To extend
these results to patients treated with antimetabolite-based therapy, we
performed Southern blot analysis to determine the TEL gene status of 104
cases of B-lineage ALL treated on Pediatric Oncology Group 8602, matched on
age, gender, and leukocyte count. There were 52 failures among the 77
patients with germline TEL, compared with only 8 failures among 27 patients
in the rearranged group. Based on a two-sided logistic regression analysis,
stratified for age (subdivided at 10 years), leukocyte count (subdivided at
50,000), and gender, the estimated odds of failing by 4 years in the
germline TEL group is 5.4 times that of the rearranged TEL group, with 95%
confidence from 1.9 to 15.6, two-sided P = .0009. Thus, the presence of a
rearranged TEL gene is also associated with an improved survival among
patients treated with antimetabolite-based therapy. Our results indicate
that all newly diagnosed ALL patients should be screened for TEL gene
rearrangements and suggest that these patients are candidates for less
intensive therapy.
Volume 89,
Issue 4,
pp. 1143-1146,
02/15/1997
Copyright © 1997 by The American Society of Hematology
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