Background: Precursor T cell ALL/LBL occurs most frequently in late childhood, adolescence, and young adulthood, with a 2:1 male predominance; it comprises 15 and 25 percent of childhood and adult ALL, respectively, and 2 percent of adult non-Hodgkin lymphoma. In adult patients prognosis is poor, due to the high incidence of relapse even after allogenic stem cell transplantation. Aims: To identify new targets, to optimize therapy, to reduce toxicity and to improve clinical outcome. Methods: We retrospectively analysed and currently report clinical outcome results about 52 newly diagnosed and younger than 60 years T-ALL patients (median age 30 years, range 14-73 years) treated, from 2006 to 2012 according to standard chemotherapy regimen, including adapted pediatric-like schedule, BFM protocol, and adult schedules. After induction, all the patients underwent consolidation for at least one course. All the patients shared the same strategy for intensification, that consisted, when available, in allogenic or autologous stem cell transplantation. Detailed data about cytogenetics and molecular biology will be provided on site. Durations of complete remission (CR) and overall survival (OS) were estimated according to the Kaplan-Meier method. The CR duration was calculated from start of CR to first evidence of disease recurrence. Results: Informed consent was obtained; after a single induction course 41/52 patients obtained a CR (78.8%) and 2 patients a partial remission (PR) (3.8%) for an overall response rate (ORR) of 82.6%. Seven patients (13.4%) had resistant disease, and 2 (3.8%) died during induction. After a median follow-up of 22.7 months, 19 patients (36.5%) are still in CR. The median CR duration and OS were 12.3 and 23.15 months, respectively. The most common grade 3 adverse events included gastro-intestinal toxicities (i.e. nausea, vomiting, mucositis and diarrhoea) and liver dysfunction. Summary and Conclusions:Our analysis confirms, in line with literature data, that, despite intensive chemotherapeutic treatments and stem cell transplantation, T-ALL and T-LBL adult patients still show a bad prognosis. The relatively satisfying induction remission rate is followed, in most cases, by a high relapse rate. Therefore, a molecular stratification approach, based on gene-expression profile analysis (Ferrando et al., Cancer Cell 2002) should be routinely performed, in order to identify new targets, to optimize therapy, to reduce toxicity and to improve clinical outcome.
Abbenante, M., Papayannidis, C., Iacobucci, I., Sartor, C., Paolini, S., Ottaviani, E., et al. (2013). CLINICAL OUTCOME OF T- ACUTE LYMPHOBLASTIC LEUKEMIA/ LYMPHOMA (T-ALL/T-LBL): THE BOLOGNA EXPERIENCE.
CLINICAL OUTCOME OF T- ACUTE LYMPHOBLASTIC LEUKEMIA/ LYMPHOMA (T-ALL/T-LBL): THE BOLOGNA EXPERIENCE
ABBENANTE, MARIACHIARA;PAPAYANNIDIS, CRISTINA;IACOBUCCI, ILARIA;SARTOR, CHIARA;LONETTI, ANNALISA;Parisi, S;Ferrari, A;GUADAGNUOLO, VIVIANA;Testoni, N;Cavo, M;
2013
Abstract
Background: Precursor T cell ALL/LBL occurs most frequently in late childhood, adolescence, and young adulthood, with a 2:1 male predominance; it comprises 15 and 25 percent of childhood and adult ALL, respectively, and 2 percent of adult non-Hodgkin lymphoma. In adult patients prognosis is poor, due to the high incidence of relapse even after allogenic stem cell transplantation. Aims: To identify new targets, to optimize therapy, to reduce toxicity and to improve clinical outcome. Methods: We retrospectively analysed and currently report clinical outcome results about 52 newly diagnosed and younger than 60 years T-ALL patients (median age 30 years, range 14-73 years) treated, from 2006 to 2012 according to standard chemotherapy regimen, including adapted pediatric-like schedule, BFM protocol, and adult schedules. After induction, all the patients underwent consolidation for at least one course. All the patients shared the same strategy for intensification, that consisted, when available, in allogenic or autologous stem cell transplantation. Detailed data about cytogenetics and molecular biology will be provided on site. Durations of complete remission (CR) and overall survival (OS) were estimated according to the Kaplan-Meier method. The CR duration was calculated from start of CR to first evidence of disease recurrence. Results: Informed consent was obtained; after a single induction course 41/52 patients obtained a CR (78.8%) and 2 patients a partial remission (PR) (3.8%) for an overall response rate (ORR) of 82.6%. Seven patients (13.4%) had resistant disease, and 2 (3.8%) died during induction. After a median follow-up of 22.7 months, 19 patients (36.5%) are still in CR. The median CR duration and OS were 12.3 and 23.15 months, respectively. The most common grade 3 adverse events included gastro-intestinal toxicities (i.e. nausea, vomiting, mucositis and diarrhoea) and liver dysfunction. Summary and Conclusions:Our analysis confirms, in line with literature data, that, despite intensive chemotherapeutic treatments and stem cell transplantation, T-ALL and T-LBL adult patients still show a bad prognosis. The relatively satisfying induction remission rate is followed, in most cases, by a high relapse rate. Therefore, a molecular stratification approach, based on gene-expression profile analysis (Ferrando et al., Cancer Cell 2002) should be routinely performed, in order to identify new targets, to optimize therapy, to reduce toxicity and to improve clinical outcome.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
