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Therapy-related acute lymphoblastic leukemia is more frequent than previously recognized and has a poor prognosis
Article first published online: 16 DEC 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 16, pages 3962–3967, 15 August 2012
How to Cite
Abdulwahab, A., Sykes, J., Kamel-Reid, S., Chang, H. and Brandwein, J. M. (2012), Therapy-related acute lymphoblastic leukemia is more frequent than previously recognized and has a poor prognosis. Cancer, 118: 3962–3967. doi: 10.1002/cncr.26735
- Issue published online: 3 AUG 2012
- Article first published online: 16 DEC 2011
- Manuscript Accepted: 8 SEP 2011
- Manuscript Revised: 7 SEP 2011
- Manuscript Received: 2 JUN 2011
- acute lymphoblastic leukemia;
- bone marrow transplantation;
- chemotherapy complications;
- radiotherapy complications
Acute lymphoblastic leukemia (ALL) occurring in patients with a history of prior chemotherapy/radiotherapy exposure has been previously reported to be rare, accounting for <2.5% of ALL cases.
All cases of adult ALL with a history of prior cytotoxic or radiation therapy at a leukemia referral center over a 13-year period were analyzed.
Twenty-three cases, representing 6.9% of all ALL cases, were identified. Of these, 17 (74%) had at least 1 high-risk feature; 8 (35%) had MLL rearrangements, and 4 were BCR-ABL+. MLL rearrangements were correlated with CD15 expression and absence of CD10, and also tended to have a shorter mean latency period and more prior topoisomerase II exposure. Twenty-one patients received induction therapy, and 18 (86%) achieved a complete response, 17 with 1 induction. Six patients have relapsed and died, and 4 others died of other complications, 2 of these postallogeneic stem cell transplantation. Median disease-free survival (DFS) and overall survival (OS) were 27 and 13.6 months, respectively, and 3-year DFS and OS were 37.1% and 37.6%, respectively.
The frequency of therapy-related ALL is higher than previously reported and has a poor prognosis, probably related to the high frequency of adverse risk features. Cancer 2012. © 2011 American Cancer Society.