Adult de novo acute myeloid leukemia with t(6;11)(q27;q23): Results from Cancer and Leukemia Group B study 8461 and review of the literature

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Adult De Novo Acute Myeloid Leukemia with t(6;11)(q27;q23): The Bordeaux, Grenoble, Marseille, Toulouse Experience

We read with interest the report by Blum et al.1 about acute myeloid leukemia (AML) with t(6;11)(q27;q23). The recent update of our data base gives us the opportunity to collect data on this rare entity.

Over a 17-year period (1984–2001) the BGMT intergroup (the Hematology Departments from Bordeaux, Grenoble, Marseille, Toulouse, and [later] Montpellier; France) entered 1007 patients (ages 15–60 years) on 4 consecutive, prospective, randomized trials.2–4 Only seven patients ultimately were lost to follow-up. Of the remaining 1000 evaluable patients, cytogenetics were available for 766 patients, and we found 6 patients with t(6;11)(q27;q23). Two of 6 patients (gender ratio = 1) had gingival involvement, 1 of 6 patients had leukemia cutis, and 1 of 6 patients had lymphadenopathy and splenomegaly. The median patient age was 39 years (range, 25–55 years), and all patients presented with French–American–British subtype M4 disease (2 of 6 patients) or subtype M5 disease (4 of 6 patients). The median white blood cell (WBC) count was 7 × 109/L (range, 3–180 × 109/L), and only 1 patient had a WBC count > 10 × 109/L. The t(6;11) was observed as a sole change in 2 patients, was associated with trisomy 21 in 2 other patients (1 patient also had an extra copy of the derivative 6), and with a structural change in the 2 other patients. Therefore, the karyotype was complex in only one patient (three abnormalities).

A complete remission (CR) was achieved in four of six patients, in two courses for two of them. All patients who achieved a CR developed recurrences after a median of 12 months (range, 4–19 months). Death occurred in all patients a median of 12 months after diagnosis (range, 1–47 months), resulting in a 14-month median survival duration and a 2-year Kaplan–Meier survival rate of 17% (95% confidence interval, 0–46%). Our data were very consistent with those of Blum et al. and confirm the poor prognosis for adults with t(6;11) AML for whom investigational approaches had to be considered.

Eric Jourdan M.D.*, Nicole Dastugue M.D.†, * Division of Hematology, Department of Internal Medicine, Hôpital Caremeau, Nimes, France, † Department of Genetics, Hôpital Purpan, Toulouse, France.

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