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Hofer KD, Bühler MM, Roncador M, Rechsteiner M, Maggio EM, Tchinda J, Schanz U, Haralambieva E, Widmer CC. Mutational patterns in therapy-related acute lymphoblastic leukemia subgroups: one step closer to unveiling the genetic odyssey. Leuk Lymphoma 2024; 65:808-815. [PMID: 38385617 DOI: 10.1080/10428194.2024.2315171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
There is increasing evidence that therapy-related acute lymphoblastic leukemia (trALL) resulting from chemo- and/or radiotherapy represents a distinct entity. However, apart from KMT2A rearrangements, which have been repeatedly reported in this subgroup, the relevance of other aberrations remains controversial due to divergent study results and sparse molecular analyses. Within our ALL patient cohort, 15% (n = 19/131) met the criteria for trALL with a high proportion of Ph + and KMT2A rearrangements. On the molecular level, the most frequently observed mutation was KMT2D, followed by CDKN2A, KRAS and DNMT3A. No TP53 mutation was detected. Outcome was particularly poor in Ph + trALL compared to Ph+ de novo ALL, which seemed to be mitigated by allogeneic stem cell transplantation. Our findings further define trALL as a distinct entity but highlight the need for further molecular genome sequencing of somatic and germline variants to advance our understanding of trALL.
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Affiliation(s)
- Kevin D Hofer
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Marco M Bühler
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland
| | - Marco Roncador
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Markus Rechsteiner
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland
| | - Ewerton M Maggio
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland
| | - Joëlle Tchinda
- Oncology Laboratory, University Children's Hospital Zurich, Switzerland
| | - Urs Schanz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
| | - Eugenia Haralambieva
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland
| | - Corinne C Widmer
- Department of Medical Oncology and Hematology, University Hospital Zurich, Switzerland
- Division of Hematology, University Hospital Basel, Switzerland
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2
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Sadowska-Klasa A, Zaucha JM, Labopin M, Bourhis JH, Blaise D, Yakoub-Agha I, Salmenniemi U, Passweg J, Fegueux N, Schroeder T, Giebel S, Brissot E, Ciceri F, Mohty M. Allogeneic hematopoietic cell transplantation is equally effective in secondary acute lymphoblastic leukemia (ALL) compared to de-novo ALL-a report from the EBMT registry. Bone Marrow Transplant 2024; 59:387-394. [PMID: 38195982 DOI: 10.1038/s41409-023-02192-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
Secondary acute lymphoblastic leukemia (s-ALL) comprises up to 10% of ALL patients. However, data regarding s-ALL outcomes is limited. To answer what is the role of allogeneic hematopoietic cell transplantation (HCT) in s-ALL, a matched-pair analysis in a 1:2 ratio was conducted to compare outcomes between s-ALL and de novo ALL (dn-ALL) patients reported between 2000-2021 to the European Society for Blood and Marrow Transplantation registry. Among 9720 ALL patients, 351 (3.6%) were s-ALL, of which 80 were in first complete remission (CR1) with a known precedent primary diagnosis 58.8% solid tumor (ST), 41.2% hematological diseases (HD). The estimated 2-year relapse incidence (RI) was 19.1% (95%CI: 11-28.9), leukemia-free survival (LFS) 52.1% (95%CI: 39.6-63.2), non-relapse mortality (NRM) 28.8% (95%CI: 18.4-40), GvHD-free, relapse-free survival (GRFS) 39.4% (95%CI: 27.8-50.7), and overall survival (OS) 60.8% (95%CI: 47.9-71.4), and did not differ between ST and HD patients. In a matched-pair analysis, there was no difference in RI, GRFS, NRM, LFS, or OS between s-ALL and dn-ALL except for a higher incidence of chronic GvHD (51.9% vs. 31.4%) in s-ALL. To conclude, patients with s-ALL who received HCT in CR1 have comparable outcomes to patients with dn-ALL.
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Affiliation(s)
- A Sadowska-Klasa
- Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland.
| | - J M Zaucha
- Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland.
| | - M Labopin
- Department of Hematology, Sorbonne University, Hopital Saint Antoine, Paris, France
| | - J H Bourhis
- Department of Hematology, Gustave Roussy Cancer Campus, BMT Service, Villejuif, France
| | - D Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - I Yakoub-Agha
- CHU de Lille, LIRIC, INSERM U995, Université de Lille, Lille, France
| | - U Salmenniemi
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - J Passweg
- University Hospital, Hematology, Basel, Switzerland
| | - N Fegueux
- CHU Lapeyronie, Département d'Hématologie Clinique, Montpellier, France
| | - T Schroeder
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - S Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - E Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Sorbonne University, and INSERM UMRs 938, Paris, France
| | - F Ciceri
- Ospedale San Raffaele, Haematology and BMT, Milan, Italy
| | - M Mohty
- Department of Hematology, Sorbonne University, Hopital Saint Antoine, Paris, France
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Riazat-Kesh YJRA, Mascarenhas J, Bar-Natan M. 'Secondary' acute lymphoblastic/lymphocytic leukemia - done playing second fiddle? Blood Rev 2023; 60:101070. [PMID: 36894417 DOI: 10.1016/j.blre.2023.101070] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
Acute lymphoblastic/lymphocytic leukemia (ALL) occurring post-cancer diagnosis (secondary ALL - sALL) is increasingly recognized as a discrete entity, constituting up to as much as 5-10% of all new ALL diagnoses, and carrying its own biologic, prognostic and therapeutic significance. In this review, we will outline the history and current state of research into sALL. We will explore the evidence for differences underlining its existence as a distinct subgroup, as well as examining what might be driving such differences etiologically, including prior chemotherapy. We will examine these distinctions on population-, chromosomal-, and molecular-levels, and we will consider whether they translate to differences in clinical outcome, and whether they do - or should - warrant differences in treatment selection.
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Affiliation(s)
| | - John Mascarenhas
- Ruttenberg Treatment Center, Tisch Cancer Institute, 1470 Madison Avenue, 3rd Floor, New York, NY, 10029., United States of America.
| | - Michal Bar-Natan
- Ruttenberg Treatment Center, Tisch Cancer Institute, 1470 Madison Avenue, 3rd Floor, New York, NY, 10029., United States of America.
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Superdock M, Komisarof J, Katerji H, Huselton E. Synchronous B-Cell Acute Lymphoblastic Leukemia and Serous Ovarian Carcinoma: A Case Report. Case Rep Oncol 2021; 14:1621-1626. [PMID: 34950006 PMCID: PMC8647092 DOI: 10.1159/000519743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022] Open
Abstract
Adult patients with B-cell acute lymphoblastic leukemia (ALL) have higher rates of antecedent and subsequent malignancies. However, synchronous identification of ALL and ovarian cancer is exceedingly rare. We report the unique case of a 65-year-old woman with synchronous B-cell ALL and low-grade serous ovarian carcinoma diagnosed after surgical intervention for a small bowel obstruction. Treatment with inotuzumab ozogamicin followed by adnexal mass resection and postoperative letrozole was successful in achieving complete remission for both her leukemia and ovarian cancer.
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Affiliation(s)
- Michael Superdock
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Justin Komisarof
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Hani Katerji
- Department of Pathology, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric Huselton
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
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Therapy-related acute lymphoblastic leukemia is a distinct entity with adverse genetic features and clinical outcomes. Blood Adv 2020; 3:4228-4237. [PMID: 31869410 DOI: 10.1182/bloodadvances.2019000925] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/06/2019] [Indexed: 01/04/2023] Open
Abstract
Patients with therapy-related acute lymphoblastic leukemia (t-ALL) represent a small subset of acute lymphoblastic leukemia (ALL) patients who received genotoxic therapy (ie, chemotherapy or radiation) for a prior malignancy. These patients should be distinguished from patients with de novo ALL (dn-ALL) and ALL patients who have a history of prior malignancy but have not received cytotoxic therapies in the past (acute lymphoblastic leukemia with prior malignancy [pm-ALL]). We report a retrospective multi-institutional study of patients with t-ALL (n = 116), dn-ALL (n = 100), and pm-ALL (n = 20) to investigate the impact of prior cytotoxic therapies on clinical outcomes. Compared with patients with pm-ALL, t-ALL patients had a significantly shorter interval between the first malignancy and ALL diagnosis and a higher frequency of poor-risk cytogenetic features, including KMT2A rearrangements and myelodysplastic syndrome-like abnormalities (eg, monosomal karyotype). We observed a variety of mutations among t-ALL patients, with the majority of patients exhibiting mutations that were more common with myeloid malignancies (eg, DNMT3A, RUNX1, ASXL1), whereas others had ALL-type mutations (eg, CDKN2A, IKZF1). Median overall survival was significantly shorter in the t-ALL cohort compared with patients with dn-ALL or pm-ALL. Patients who were eligible for hematopoietic cell transplantation had improved long-term survival. Collectively, our results support t-ALL as a distinct entity based on its biologic and clinical features.
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Murray NP, Orrego S, López MA, Munoz L, Minzer S. Common B-cell acute lymphoblastic leukaemia in a 70-year-old woman presenting 2 years after carboplatin-taxane radiotherapy for endometrial cancer. Ecancermedicalscience 2019; 13:972. [PMID: 31921343 PMCID: PMC6834386 DOI: 10.3332/ecancer.2019.972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Indexed: 11/16/2022] Open
Abstract
Therapy-related acute lymphoblastic leukaemia (t-ALL) is a poorly defined entity and is not featured in the World Health Organization classification as a distinct clinical entity from acute lymphoblastic leukaemia (ALL), thus differing from therapy-related acute myeloid leukaemia and myelodysplasia. We present a case of t-ALL occurring 18 months after treatment for metastatic endometrial cancer with a regimen of carboplatin, paclitaxel and radiotherapy. The patient presented with severe pancytopenia and diagnosed with common-B ALL, and the cytogenetic analysis showed a previously unreported deletion in chromosome 19 (q13.1) in 100% of the blast cells. The patient declined further therapy and died 1 month later. This rare but serious side effect of chemo-radiotherapy should be considered when deciding on treatment options for gynaecological cancers.
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Affiliation(s)
- Nigel P Murray
- Consultant Haematologist, Department of Medicine, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, 7770199, Chile.,Professor Haematology, Faculty of Medicine, University Finis Terrae, Av Pedro de Valdivia 1509, Providencia, Santiago
| | - Shenda Orrego
- Physician General Medicine, Department of Medicine, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, 7770199, Chile.,Tutor, Faculty of Medicine, University Mayor, Renato Sánchez 4369, Las Condes, Santiago, 27550224, Chile
| | - Marco Antonio López
- Physician General Medicine, Department of Medicine, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, 7770199, Chile.,Tutor, Faculty of Medicine, University Mayor, Renato Sánchez 4369, Las Condes, Santiago, 27550224, Chile
| | - Lorena Munoz
- Tutor, Faculty of Medicine, University Mayor, Renato Sánchez 4369, Las Condes, Santiago, 27550224, Chile.,Consultant Internal Medicine, Department of Medicine, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, 7770199, Chile
| | - Simona Minzer
- Physician General Medicine, Department of Medicine, Hospital de Carabineros de Chile, Simón Bolívar 2200, Ñuñoa, Santiago, 7770199, Chile
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