The clinical characteristics, therapy and outcome of 85 adults with acute lymphoblastic leukemia and t(4;11)(q21;q23)/MLL-AFF1 prospectively treated in the UKALLXII/ECOG2993 trial

David I. Marks, Anthony V. Moorman, Lucy Chilton, Elisabeth Paietta, Amir Enshaie, Gordon de Wald, Christine J. Harrison, Adele K. Fielding, Letizia Foroni, Anthony H. Goldstone, Mark R. Litzow, Selina M. Luger, Andrew K. McMillan, Janis Racevskis, Jacob M. Rowe, Martin S. Tallman, Peter Wiernik, Hillard M. Lazarus

Research output: Contribution to journalArticle

Abstract

The biology and outcome of adult t(4;11)(q21;q23)/MLL-AFF1 acute lymphoblastic leukemia are poorly understood. We describe the outcome and delineate prognostic factors and optimal post-remission therapy in 85 consecutive patients (median age 38 years) treated uniformly in the prospective trial UKALLXII/ECOG2993. The immunophenotype of this leukemia was pro-B (CD10NEG). Immaturity was further suggested by high expression of the stem-cell antigens, CD133 and CD135, although CD34 expression was significantly lower than in t(4;11)- negative patients. Complete remission was achieved in 77 (93%) patients but only 35% survived 5 years (95% CI: 25-45%); the relapse rate was 45% (95% CI: 33-58%). Thirty-one patients underwent allogeneic transplantation in first remission (15 sibling donors and 16 unrelated donors): with 5-year survival rates of 56% and 67% respectively, only 2/31 patients relapsed. This compares with a 24% survival rate and 59% relapse rate in 46 patients who received post-remission chemotherapy. A major determinant of outcome was age with 71% of patients aged <25 years surviving. Younger patients had lower relapse rates (19%) but most received allografts in first complete remission. In conclusion, multivariate analysis did not demonstrate an advantage of allografting over chemotherapy but only five younger patients received chemotherapy. Prospective trials are required to determine whether poor outcomes in older patients can be improved by reduced-intensity conditioning allografts. NCT00002514 www.clinicaltrials.gov.

Original languageEnglish (US)
Pages (from-to)945-952
Number of pages8
JournalHaematologica
Volume98
Issue number6
DOIs
StatePublished - Jun 6 2013
Externally publishedYes

ASJC Scopus subject areas

  • Hematology

Fingerprint Dive into the research topics of 'The clinical characteristics, therapy and outcome of 85 adults with acute lymphoblastic leukemia and t(4;11)(q21;q23)/MLL-AFF1 prospectively treated in the UKALLXII/ECOG2993 trial'. Together they form a unique fingerprint.

  • Cite this

    Marks, D. I., Moorman, A. V., Chilton, L., Paietta, E., Enshaie, A., de Wald, G., Harrison, C. J., Fielding, A. K., Foroni, L., Goldstone, A. H., Litzow, M. R., Luger, S. M., McMillan, A. K., Racevskis, J., Rowe, J. M., Tallman, M. S., Wiernik, P., & Lazarus, H. M. (2013). The clinical characteristics, therapy and outcome of 85 adults with acute lymphoblastic leukemia and t(4;11)(q21;q23)/MLL-AFF1 prospectively treated in the UKALLXII/ECOG2993 trial. Haematologica, 98(6), 945-952. https://doi.org/10.3324/haematol.2012.081877