Prognostic factors in adult acute lymphoblastic leukaemia

Abstract

SummaryTreatment of acute lymphoblastic leukaemia (ALL) in adults presents a formidable challenge. While overall results have improved over the past 3 decades, the long-term survival for patients aged less than 60 years is only in the range of 30-40% and is 10-15% if between 60 and 70 years and <5% for those over 70 years. The historic lack of clear-cut biological prognostic factors has led to over-or under-treatment of some patients. Response to initial therapy is an important prognosticator of outcome based on disease biology, as well as pharmacogenetics, which include the patient's response to drugs given. The more widespread availability of allogeneic transplantation and reduced-intensity regimens for older patients have opened up this curative modality to a greater number of patients. Hopefully, those options, as well as novel cytogenetic and molecular markers, will enable a better selection of patients who undergo intensive therapies and finally break the 30-40% cure barrier for adults with ALL.

Reduced-intensity allogeneic stem cell transplantation for patients aged 50 years or older with B-cell ALL in remission: a retrospective study by the Adult ALL Working Group of the Japan Society for Hematopoietic Cell Transplantation

“…A cutoff value of 30 Â 10 9 /L has often been used in clinical studies of B-cell ALL and its significance has been shown in previous reports. 3,17 Marks reported that a WBC 425 Â 10 9 /L at diagnosis predicted a worse outcome for adult patients with ALL in CR1/2 who received Fludarabine-containing RIST for elderly B-ALL H Kanamori et al transplantation after either full conditioning (n ¼ 1421) or reduced-intensity conditioning (n ¼ 92). 14 However, there has been no report about the clinical impact of WBC at diagnosis on survival among patients receiving RIST alone.…”

“…According to previous studies, factors such as age, immunophenotype, WBC and cytogenetic abnormalities are associated with the outcome of chemotherapy and/or transplantation for ALL. 17 The Ph chromosome is the most frequent and clinically significant abnormality in adult ALL, with an incidence ranging from 15 to 50% among older patients with B-cell ALL. 18 Use of tyrosine kinase inhibitors combined with chemotherapy has altered the prognosis of these patients.…”

Novel gene targets detected by genomic profiling in a consecutive series of 126 adults with acute lymphoblastic leukemia

“…1 Adults with ALL, on the other hand, still have a very poor prognosis; the long-term survival rate for adult cases is a mere 30-40% and decreases with age. 2,3 Studies have shown that younger adults treated on pediatric protocols have an increased overall survival compared with those on adult protocols. 4,5 However, it should be emphasized that adult ALL differs significantly from pediatric ALL as regards complete remission rates, minimal residual disease response level and risk group assignments, even when treated on pediatric protocols.…”

Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology

“…In childhood ALL, males tended to have a worse overall prognosis than females did, 19,42 although that difference was not as clear in adult ALL. 43 In AML, males fared worse than females did. 44,45 Strong recommendation for testing for KIT mutation in adult patients with CBF-AML Expert consensus opinion for testing for KIT mutation in pediatric patients with CBF-AML 18.…”