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Reassessment of the prognostic significance of hypodiploidy in pediatric patients with acute lymphoblastic leukemia
Article first published online: 5 NOV 2003
Copyright © 2003 American Cancer Society
Volume 98, Issue 12, pages 2715–2722, 15 December 2003
How to Cite
Raimondi, S. C., Zhou, Y., Mathew, S., Shurtleff, S. A., Sandlund, J. T., Rivera, G. K., Behm, F. G. and Pui, C.-H. (2003), Reassessment of the prognostic significance of hypodiploidy in pediatric patients with acute lymphoblastic leukemia. Cancer, 98: 2715–2722. doi: 10.1002/cncr.11841
- Issue published online: 4 DEC 2003
- Article first published online: 5 NOV 2003
- Manuscript Accepted: 8 SEP 2003
- Manuscript Revised: 29 AUG 2003
- Manuscript Received: 9 JUL 2003
- National Cancer Institute. Grant Numbers: CA 20180, CA 21765
- State of Tennessee
- American Lebanese Syrian Associated Charities (ALSAC)
- pediatric acute lymphoblastic leukemia;
- prognosis by ploidy subgroup
The purpose of the current study was to evaluate the cytogenetic features of the hypodiploid leukemic cells of pediatric patients with this rare subgroup of acute lymphoblastic leukemia (ALL). In addition, the authors determined whether subdivision of the hypodiploid category served a prognostic purpose for these patients.
The authors evaluated the cytogenetic records of 979 patients with ALL admitted to St. Jude Children's Research Hospital (Memphis, TN) between 1984 and 1999.
Of 67 patients (6.8%) whose leukemic cells contained a modal number (MN) of chromosomes less than or equal to 45 (i.e., hypodiploid leukemic cells), 57 had an MN of 45 and 10 had an MN of less than 45. In 19 patients, cells with an MN of 45 had a whole chromosome missing (42%), which was a sex chromosome in 12 patients (63%). Leukemic cells with an MN of 45 contained dicentric chromosomes (n = 33) formed from chromosome 9p (55%), 12p (18%), or both (21%). The ETV6-CBFA2 fusion was present in 39% of 28 evaluable B-lineage cases with an MN of 45. The event-free survival rate (EFS) for patients with hypodiploid leukemic cells of MN less than 45 (5-year EFS = 20.0% ± 10.3%) was significantly (P < 0.001) lower than that for patients with leukemic cells of MN greater than or equal to 45 (5-year EFS = 74.9% ± 1.6%).
Low hypodiploidy (MN < 45) should be recognized as a high-risk feature in pediatric ALL. Only two hypodiploid groups (MN < 45 and MN = 45) may be necessary in prognostic assessments. Cancer 2003;98:2715–22. © 2003 American Cancer Society.