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. 2021 Dec 14;5(23):5415-5419.
doi: 10.1182/bloodadvances.2021004580.

Outcomes of acute lymphoblastic leukemia with KMT2A (MLL) rearrangement: the MD Anderson experience

Guillaume Richard-Carpentier  1   2 , Hagop M Kantarjian  1 , Guilin Tang  3 , C Cameron Yin  3 , Joseph D Khoury  3 , Ghayas C Issa  1 , Fadi Haddad  1 , Nitin Jain  1 , Farhad Ravandi  1 , Nicholas J Short  1 , Courtney D DiNardo  1 , Koichi Takahashi  1 , Marina Y Konopleva  1 , Naval G Daver  1 , Tapan Kadia  1 , Guillermo Garcia-Manero  1 , Rebecca Garris  1 , Susan O'Brien  4 , Elias Jabbour  1
Affiliations

Outcomes of acute lymphoblastic leukemia with KMT2A (MLL) rearrangement: the MD Anderson experience

Guillaume Richard-Carpentier et al. Blood Adv. .

Abstract

Acute lymphoblastic leukemia (ALL) with t(4;11)(q21;q23)-KMT2A-AFF1 is associated with a poor prognosis. The impact of KMT2A rearrangements other than t(4;11) is uncertain, and the benefit of allogeneic stem cell transplantation (HSCT) is unclear. We reviewed adult patients with ALL treated at our institution from 1984 to 2019 and identified 50 out of 1102 (5%) with KMT2A rearrangement, including 42 (84%) with t(4;11)/KMT2A-AFF1 and 8 (16%) with other gene partners. The median age was 45 years (range, 18-78 years); median white blood cell count was 109.0 3 109/L (range, 0.5-1573.0). The complete remission (CR) rate was 88%, and the rate of measurable residual disease negativity by flow cytometry at CR was 41% (76% overall during follow-up). At the last follow-up, 14 patients were alive. The 5-year overall survival (OS) rate was 18% (95% confidence interval [CI], 9% to 35%), with no difference between t(4;11) and other KMT2A rearrangements (P 5 .87). In a 4-month landmark analysis, the 5-year OS rate was 32% (95% CI, 14% to 70%) in patients who underwent HSCT vs 11% (95% CI, 3-39) in others (P 5 .10). Our study confirms the poor prognosis of ALL with any KMT2A rearrangement and the role of HSCT in these patients.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Clinical outcomes of patients with KMT2A-rearranged ALL. OS (A) and RFS (B) according to the type of KMT2A rearrangement. OS (C) and RFS (D) according to MRD status at time of CR. OS (E) and RFS (F) with landmark analysis for HSCT in CR1.
See this image and copyright information in PMC

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