Background
Philadelphia (Ph) positive B-lymphoblastic leukemia exhibits immunophenotypic, karyotypic, and molecular genetic heterogeneity. The prognostic significance of these parameters was assessed in the context of intensive tyrosine kinase inhibitor (TKI)-based chemotherapy.
Methods
We studied 65 cases of adult Ph-positive ALL treated with TKI-based therapy, correlated their clinicopathologic heterogeneity with patient outcome, and compared the findings with 60 cases of adult diploid B-ALL treated with similar chemotherapy without TKI.
Results
Ph-positive ALL was associated with older age (p=0.01) and common-B immunophenotype characterized by higher a frequency of co-expression of CD13 (p=0.004), CD66c (p=0.007), and CD25 (p<0.001) with a lower frequency of CD15 expression (p<0.001). Conventional karyotypic analyses showed the Ph chromosome was the sole abnormality in 19 cases (30%), present with other aberrancies in 43 cases (65%), and absent (detectable only by fluorescence in situ hybridization [FISH] or quantitative RT-PCR) in 3 cases (5%). BCR-ABL was confirmed in all cases by FISH or RT-PCR [p190 in 49 (77%) and p210 in 15 (23%), respectively]. Supernumerical Ph correlated with a higher incidence of CD20 expression (p<0.001), whereas p210 correlated with aberrant CD25 expression (p=0.05). Outcomes were not influenced by the degree of karyotypic complexity (including presence or absence of supernumerical Ph); CD20 expression, or myeloid antigen expression (CD13, CD33, CD66c). CD25 expression was associated with an inferior survival in univariate analysis (p=0.051), but not by multivariable analysis (p=0.092).
Conclusions
In the context of intensive TKI-based chemotherapy, the immunophenotypic, karyotypic, and molecular heterogeneity of Ph-positive ALL no longer influences outcome.