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Clinical heterogeneity in childhood acute lymphoblastic leukemia with 11q23 rearrangements

Leukemia volume 17, pages 700–706 (2003)Cite this article

Abstract

To assess the clinical heterogeneity among patients with acute lymphoblastic leukemia (ALL) and various 11q23 abnormalities, we analyzed data on 497 infants, children and young adults treated between 1983 and 1995 by 11 cooperative groups and single institutions. The substantial sample size allowed separate analyses according to age younger or older than 12 months for the various cytogenetic subsets. Infants with t(4;11) ALL had an especially dismal prognosis when their disease was characterized by a poor early response to prednisone (P=0.0005 for overall comparison; 5-year event-free survival (EFS), 0 vs 23±12% s.e. for those with good response), or age less than 3 months (P=0.0003, 5-year EFS, 5±5% vs 23.4±4% for those over 3 months). A poor prednisone response also appeared to confer a worse outcome for older children with t(4;11) ALL. Hematopoietic stem cell transplantation failed to improve outcome in either age group. Among patients with t(11;19) ALL, those with a T-lineage immunophenotype, who were all over 1 year of age, had a better outcome than patients over 1 year of age with B-lineage ALL (overall comparison, P=0.065; 5-year EFS, 88±13 vs 46±14%). In the heterogeneous subgroup with del(11)(q23), National Cancer Institute-Rome risk criteria based on age and leukocyte count had prognostic significance (P=0.04 for overall comparison; 5-year EFS, 64±8% (high risk) vs 83±6% (standard risk)). This study illustrates the marked clinical heterogeneity among and within subgroups of infants or older children with ALL and specific 11q23 abnormalities, and identifies patients at particularly high risk of failure who may benefit from innovative therapy.

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Acknowledgements

This work was supported in part by grants from the US National Institutes of Health (CA 31566, CA51001, CA21765, CA78824, CA29139, and CA37379); a Center of Excellence Grant from the State of Tennessee, USA; Midwest Athletes Against Childhood Cancer Fund; the Associazione Italiana Ricerca sul Cancro, Fondazione Tettamanti, and Consiglio Nazionale Ricerche-Ministero Istruzione Universitá Ricerca; the Deutsche Krebshilfe, Bonn, and Madeleine Schickedanz Foundation, Fürth, Germany; Cancer Research UK; and the American Lebanese Syrian Associated Charities. C-H Pui is the American Cancer Society-FM Kirby Clinical Research Professor.

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Authors and Affiliations

  1. St Jude Children's Research Hospital, Memphis, TN, USA

    C-H Pui, J M Boyett, W E Evans, P L Harrison, S C Raimondi & Y Zhou

  2. University of Tennessee, Memphis, TN, USA

    C-H Pui, J M Boyett, W E Evans, P L Harrison, S C Raimondi & Y Zhou

  3. UK Medical Research Council Childhood Leukaemia Working Party, UK

    J M Chessells, O B Eden, C J Harrison & S Richards

  4. Children's Oncology Group, USA

    B Camitta, A Carroll, N Heerema, J Pullen, H Sather, J Shuster & P S Gaynon

  5. French Acute Lymphoblastic Leukemia Cooperative Group, France

    A Baruchel

  6. Associazione Italiana di Ematologia ed Oncologia Pediatrica, Italy

    A Biondi, G Masera & M G Valsecchi

  7. Berlin-Frankfurt Münster Study Group, Germany

    H Gadner, J Harbott, H Riehm & M Schrappe

  8. Cooperative ALL Study Group, Germany

    D O Harms & G Janka-Schaub

  9. Dutch Childhood Leukemia Study Group, The Netherlands

    W Kamps

  10. Dana Farber Cancer Institute, USA

    S Sallan & L B Silverman

  11. Harvard Medical School, USA

    S Sallan & L B Silverman

  12. European Organization for Research and Treatment of Cancer, France, Belgium

    E Vilmer

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Pui, CH., Chessells, J., Camitta, B. et al. Clinical heterogeneity in childhood acute lymphoblastic leukemia with 11q23 rearrangements. Leukemia 17, 700–706 (2003). https://doi.org/10.1038/sj.leu.2402883

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