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Outcome of treatment in childhood acute lymphoblastic leukaemia with rearrangements of the 11q23 chromosomal region

Outcome of treatment in childhood acute lymphoblastic leukaemia with rearrangements of the 11q23 chromosomal region
Outcome of treatment in childhood acute lymphoblastic leukaemia with rearrangements of the 11q23 chromosomal region
Background: The prognosis and optimum treatment of childhood acute lymphoblastic leukaemia (ALL) with abnormalities of chromosomal band 11q23 are controversial. We aimed to identify prognostic factors that might help in planning future therapy, and to assess the effectiveness of haemopoietic stem-cell transplantation in patients with the t(4;11) translocation, which is associated with a particularly poor outcome.
Methods: We reviewed data on 497 children and young adults who had ALL with various 11q23 abnormalities, including the translocations t(4;11), t(9;11), and t(11;19). All patients were treated with intensive chemotherapy, with or without haemopoietic stem-cell transplantation in first complete remission, by 11 study groups and single institutions from 1983 to 1995.
Findings: Age was the most important prognostic factor. In a Cox's proportional-hazard model stratified by 11q23 abnormalities, infants younger than 1 year fared significantly worse than patients 1 year of age or older (hazard ratio for event-free survival 1·84 [95% CI 1·38–2·47], p=0·0001). Among infants, any category of 11q23 abnormality conferred a dismal outcome, whereas in older patients, t(4;11) and t(9;11) were associated with a worse outcome than were other 11q23 changes. In the largest subgroup–256 patients with t(4;11)–any type of transplantation was associated with significantly worse disease-free survival (1·61 [1·10–2·35], p=0·014) and overall survival (1·76 [1·08–2·45], p=0·004) compared with chemotherapy only. Even transplantation with stem cells from HLA-matched related or HLA-matched unrelated donors tended to be associated with a worse outcome than chemotherapy alone.
Interpretation: The prognosis of acute lymphoblastic leukaemia with an 11q23 abnormality is particularly dismal in infants. Allogeneic transplantation with haemopoietic stem cells from an HLA-matched related donor does not seem to improve the clinical outcome in patients with t(4;11)-positive leukaemia.
1909-1915
Pui, Ching-Hon
f2618af6-f55a-4a7c-b535-640d7a190001
Gaynon, Paul S.
19aca218-1323-42e6-895f-a664c3d273c7
Boyett, James M.
bd39d808-c001-4ed8-a069-2124399efaae
Chessells, Judith M.
ef8a8921-a29b-48d8-8ef7-5c3ff4463d82
Baruchel, André
b3e85451-f368-4739-8946-1e1d9191e9ca
Kamps, Willem
9a0f848b-af45-4c40-adbb-d246e97dd6cd
Silverman, Lewis B.
4c6234c5-103c-4aaa-8eee-7ac1a5e89621
Biondi, Andrea
1bbefd63-8c9e-44f3-bf13-2206e57020a9
Harms, Dörthe O.
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Vilmer, Etienne
c1a48d6a-4a1a-4571-8b68-4af5d5374406
Schrappe, Martin
b0b28e7e-065e-4986-b14f-343203e21f27
Camitta, Bruce
c4983b2b-d6cf-48d6-bdfc-bad507993aaa
Pui, Ching-Hon
f2618af6-f55a-4a7c-b535-640d7a190001
Gaynon, Paul S.
19aca218-1323-42e6-895f-a664c3d273c7
Boyett, James M.
bd39d808-c001-4ed8-a069-2124399efaae
Chessells, Judith M.
ef8a8921-a29b-48d8-8ef7-5c3ff4463d82
Baruchel, André
b3e85451-f368-4739-8946-1e1d9191e9ca
Kamps, Willem
9a0f848b-af45-4c40-adbb-d246e97dd6cd
Silverman, Lewis B.
4c6234c5-103c-4aaa-8eee-7ac1a5e89621
Biondi, Andrea
1bbefd63-8c9e-44f3-bf13-2206e57020a9
Harms, Dörthe O.
57a32914-3bf5-4fd0-84ad-0df91ba0eb7a
Vilmer, Etienne
c1a48d6a-4a1a-4571-8b68-4af5d5374406
Schrappe, Martin
b0b28e7e-065e-4986-b14f-343203e21f27
Camitta, Bruce
c4983b2b-d6cf-48d6-bdfc-bad507993aaa

Pui, Ching-Hon, Gaynon, Paul S., Boyett, James M., Chessells, Judith M., Baruchel, André, Kamps, Willem, Silverman, Lewis B., Biondi, Andrea, Harms, Dörthe O., Vilmer, Etienne, Schrappe, Martin and Camitta, Bruce (2002) Outcome of treatment in childhood acute lymphoblastic leukaemia with rearrangements of the 11q23 chromosomal region. The Lancet, 359 (9321), 1909-1915. (doi:10.1016/S0140-6736(02)08782-2).

Record type: Article

Abstract

Background: The prognosis and optimum treatment of childhood acute lymphoblastic leukaemia (ALL) with abnormalities of chromosomal band 11q23 are controversial. We aimed to identify prognostic factors that might help in planning future therapy, and to assess the effectiveness of haemopoietic stem-cell transplantation in patients with the t(4;11) translocation, which is associated with a particularly poor outcome.
Methods: We reviewed data on 497 children and young adults who had ALL with various 11q23 abnormalities, including the translocations t(4;11), t(9;11), and t(11;19). All patients were treated with intensive chemotherapy, with or without haemopoietic stem-cell transplantation in first complete remission, by 11 study groups and single institutions from 1983 to 1995.
Findings: Age was the most important prognostic factor. In a Cox's proportional-hazard model stratified by 11q23 abnormalities, infants younger than 1 year fared significantly worse than patients 1 year of age or older (hazard ratio for event-free survival 1·84 [95% CI 1·38–2·47], p=0·0001). Among infants, any category of 11q23 abnormality conferred a dismal outcome, whereas in older patients, t(4;11) and t(9;11) were associated with a worse outcome than were other 11q23 changes. In the largest subgroup–256 patients with t(4;11)–any type of transplantation was associated with significantly worse disease-free survival (1·61 [1·10–2·35], p=0·014) and overall survival (1·76 [1·08–2·45], p=0·004) compared with chemotherapy only. Even transplantation with stem cells from HLA-matched related or HLA-matched unrelated donors tended to be associated with a worse outcome than chemotherapy alone.
Interpretation: The prognosis of acute lymphoblastic leukaemia with an 11q23 abnormality is particularly dismal in infants. Allogeneic transplantation with haemopoietic stem cells from an HLA-matched related donor does not seem to improve the clinical outcome in patients with t(4;11)-positive leukaemia.

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Published date: 2002
Organisations: Cancer Sciences

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Local EPrints ID: 26543
URI: http://eprints.soton.ac.uk/id/eprint/26543
PURE UUID: f44b83ae-c4ae-4559-ae52-0234cb009df1

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Date deposited: 20 Apr 2006
Last modified: 05 Oct 2018 12:04

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Contributors

Author: Ching-Hon Pui
Author: Paul S. Gaynon
Author: James M. Boyett
Author: Judith M. Chessells
Author: André Baruchel
Author: Willem Kamps
Author: Lewis B. Silverman
Author: Andrea Biondi
Author: Dörthe O. Harms
Author: Etienne Vilmer
Author: Martin Schrappe
Author: Bruce Camitta

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