Adults with acute lymphoblastic leukemia and translocation (1;19) abnormality have a favorable outcome with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and high-dose cytarabine chemotherapy

Abstract

Background: Among the well described cytogenetic abnormalities in adults with acute lymphoblastic leukemia (ALL), a translocation involving chromosomes 1 and 19 (t[1;19] [q23;p13]) occurs in a small subset but has been associated variously with an intermediate prognosis or a bad prognosis in different studies.

Methods: Adults with ALL and t(1;19) who were treated at The University of Texas M. D. Anderson Cancer Center were reviewed. Their clinical features and outcomes were compared with those of patients who had other cytogenetic abnormalities. The study endpoints included the complete remission (CR) rate, the complete response duration (CRD), and overall survival (OS).

Results: Of 411 adults with pre-B-cell ALL, 12 patients had t(1;19). Ten of 12 patients with t(1;19) received hyperfractionated cyclophosphamide, vincristine, doxorubicin (Adriamycin), and dexamethasone alternating with methotrexate and high-dose cytarabine (hyper-CVAD) chemotherapy; and the other 2 patients received combined vincristine, doxorubicin, and dexamethasone (VAD). All 12 patients achieved CR, and the 3-year survival rate was 73%. Patients with t(1;19) had significantly better CRD and OS compared with all other patients combined and compared individually with patients who had Philadelphia chromosome-positive, t(4;11), and lymphoma-like abnormalities (deletion 6q, addition q14q, t[11;14], and t[14;18]).

Conclusions: Adults with ALL and t(1;19) had an excellent prognosis when the received the hyper-CVAD regimen.

FIGURE 1

Complete remission duration of patients with a translocation involving chromosomes 1 and 19 (t[1;19]) versus patients in other cytogenetic groups. DIP indicates diploid group; LYMPH, lymphoma-like group; PH+, Philadelphia chromosome-positive group; MISC, miscellaneous group.

FIGURE 2

Overall survival of patients with a translocation involving chromosomes 1 and 19 (t[1;19]) versus patients in other cytogenetic groups. DIP indicates diploid group; LYMPH, lymphoma-like group; PH+, Philadelphia chromosome-positive group; MISC, miscellaneous group.

FIGURE 3

(Top) Remission duration and (bottom) overall survival of patients with a translocation involving chromosomes 1 and 19 (t[1;19]) versus all other patient groups with pre-B-cell acute lymphoblastic leukemia. DIP indicates diploid group; LYMPH, lymphoma-like group; PH+, Philadelphia chromosome-positive group; MISC, miscellaneous group.