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Randomized Controlled Trial
. 2009 Dec 10;114(25):5136-45.
doi: 10.1182/blood-2009-08-231217.

T-cell acute lymphoblastic leukemia in adults: clinical features, immunophenotype, cytogenetics, and outcome from the large randomized prospective trial (UKALL XII/ECOG 2993)

David I Marks  1 , Elisabeth M Paietta, Anthony V Moorman, Susan M Richards, Georgina Buck, Gordon DeWald, Adolfo Ferrando, Adele K Fielding, Anthony H Goldstone, Rhett P Ketterling, Mark R Litzow, Selina M Luger, Andrew K McMillan, Marc R Mansour, Jacob M Rowe, Martin S Tallman, Hillard M Lazarus
Affiliations
Randomized Controlled Trial

T-cell acute lymphoblastic leukemia in adults: clinical features, immunophenotype, cytogenetics, and outcome from the large randomized prospective trial (UKALL XII/ECOG 2993)

David I Marks et al. Blood. .

Abstract

The biology and outcome of adult T-cell acute lymphoblastic leukemia are poorly understood. We present here the clinical and biologic features of 356 patients treated uniformly on the prospective trial (UKALL XII/ECOG 2993) with the aim of describing the outcome and identifying prognostic factors. Complete remission was obtained in 94% of patients, and 48% survived 5 years. Positivity of blasts for CD1a and lack of expression of CD13 were associated with better survival (P = .01 and < .001, respectively). NOTCH1 and CDKN2A mutations were seen in 61% and 42% of those tested. Complex cytogenetic abnormalities were associated with poorer survival (19% vs 51% at 5 years, P = .006). Central nervous system involvement at diagnosis did not affect survival (47% vs 48%, P = not significant). For 99 patients randomized between autograft and chemotherapy, 5-year survival was 51% in each arm. Patients with a matched sibling donor had superior 5-year survival to those without donors (61% vs 46%, chi(2), P = .02); this was the result of less relapse (25% vs 51% at 5 years, P < .001). Only 8 of 123 relapsed patients survive. This study provides a baseline for trials of new drugs, such as nelarabine, and may allow risk-adapted therapy in patients with poor-prognosis T-cell ALL.

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Figures

Figure 1
Figure 1
Patient flow diagram.
Figure 2
Figure 2
Overall survival from diagnosis of patients with B- versus T- lineage disease.
Figure 3
Figure 3
Overall survival from diagnosis by WBC in patients with T-lineage ALL.
Figure 4
Figure 4
Effect of randomized treatment on overall survival in patients. (A) Survival curve in patients with T lineage. (B) Forest plot within lineage subgroups. Survival was measured from randomization. The forest plot represents the treatment effect (odds ratio) and its 95% CI by a square and horizontal line (within subgroups) and the center and width of a diamond (overall).
Figure 5
Figure 5
Effect of matched sibling donor availability on outcome. (A) Survival curve in patients with T lineage. (B) Forest plot of effects on relapse and on nonrelapse mortality within lineage subgroups. Survival was measured from diagnosis. Forest plot format is as in Figure 4.
See this image and copyright information in PMC

References

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