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Ferraro F, Gao F, Stockerl-Goldstein K, Westervelt P, DiPersio JF, Ghobadi A. Secondary acute lymphoblastic leukemia, a retrospective analysis from Washington University and meta-analysis of published data. Leuk Res 2018; 72:86-91. [PMID: 30114560 DOI: 10.1016/j.leukres.2018.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022]
Abstract
Secondary acute lymphoblastic leukemia (s-ALL) is rare and poorly defined and data regarding outcomes post-transplant are lacking. Here, we report a detailed analysis of s-ALL at our Institution. Among 211 eligible patients with ALL from 2006 to 2017, 30 (14%) were defined as s-ALL and the remaining as primary ALL (p-ALL). s-ALL patients were older and had higher incidence of adverse risk factors. Overall response (OR) after induction was not different between s-ALL and p-ALL (79% versus 90% respectively, p = 0.106). S-ALL group had a higher risk of relapse (RFS) and death (RFS HR = 1.93, 95% CI 1.2-3.12, p = 0.007. OS HR: =1.95, 95% CI 1.18-3.23, p = 0.01). In multivariate analysis, the adverse effect of s-ALL on RFS and OS was no longer significant, however a pooled meta-analysis of our and published data indicated that s-ALL is an independent risk factor for lower OS (HR: 1.30, 95% CI: 1.11-1.52, p < 0.01). Myeloablative allogeneic transplantation in s-ALL was associated with lower rates of relapse and higher transplant related mortality without improvement in OS. These data indicate that s-ALL status should be considered for risk- stratification of newly diagnosed ALL. The optimal conditioning regimen for s-ALL patients undergoing allogeneic stem cell transplantation needs to be evaluated in a larger study.
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Affiliation(s)
- Francesca Ferraro
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Feng Gao
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Keith Stockerl-Goldstein
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Peter Westervelt
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - John F DiPersio
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Armin Ghobadi
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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Rosenberg AS, Brunson A, Paulus JK, Tuscano J, Wun T, Keegan THM, Jonas BA. Secondary acute lymphoblastic leukemia is a distinct clinical entity with prognostic significance. Blood Cancer J 2017; 7:e605. [PMID: 28885611 PMCID: PMC5709750 DOI: 10.1038/bcj.2017.81] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/20/2017] [Indexed: 01/21/2023] Open
Abstract
The effect of prior malignancy on the risk of developing, and prognosis of, acute lymphoblastic leukemia (ALL) is unknown. This observational study utilized the California Cancer Registry to estimate the risk of developing ALL after a prior malignancy using standardized incidence ratios (SIRs, 95% confidence intervals). ALL occurring after a malignancy with an SIR>1 (increased-risk (IR) malignancies) was considered secondary ALL (s-ALL). Adjusted hazard ratios (aHRs, 95% confidence intervals) compared the effect of s-ALL with de novo ALL on overall survival. A total of 14 481 patients with ALL were identified (1988–2012) and 382 (3%) had a known prior malignancy. Any prior malignancy predisposed patients to developing ALL: SIR 1.62 (1.45–1.79). Hematologic malignancies (SIR 5.57, 4.38–6.98) and IR-solid tumors (SIR 2.11, 1.73–2.54) increased the risk of developing ALL. s-ALL increased the risk of death compared with de novo ALL (aHR 1.38 (1.16–1.63)) and this effect was more pronounced among younger patients (age<40 years: aHR 4.80 (3.15–7.30); age⩾40 years: aHR 1.40 (1.16–1.69)) (interaction P<0.001). This population-based study demonstrates that s-ALL is a distinct entity that occurs after specific malignancies and carries a poor prognosis compared with de novo ALL, particularly among patients <40 years of age.
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Affiliation(s)
- A S Rosenberg
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA, USA.,University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - A Brunson
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - J K Paulus
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - J Tuscano
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.,VA Northern California Health Care System, Sacramento, CA, USA
| | - T Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA, USA.,University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.,VA Northern California Health Care System, Sacramento, CA, USA
| | - T H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA, USA.,University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - B A Jonas
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA, USA.,University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.,VA Northern California Health Care System, Sacramento, CA, USA
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Ganzel C, Devlin S, Douer D, Rowe JM, Stein EM, Tallman MS. Secondary acute lymphoblastic leukaemia is constitutional and probably not related to prior therapy. Br J Haematol 2015; 170:50-5. [PMID: 25823602 DOI: 10.1111/bjh.13386] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/04/2015] [Indexed: 01/21/2023]
Abstract
Very little is known about secondary acute lymphoblastic leukaemia (s-ALL). This retrospective analysis studied a cohort of s-ALL patients treated at a single centre between 1994 and 2013, while comparing therapy-associated ALL (t-ALL) and antecedent malignancy ALL (am-ALL) patients. Thirty-two patients with s-ALL were identified. The overall incidence was 9.4% among ALL adults while T-cell s-ALL was rare (12% of s-ALLs). The median time interval between two malignant diagnoses was 5.3 years (range: 0.1-28). In contrast to previous reports, most of the s-ALLs were CD10 + and without KMT2A (MLL) abnormalities. The overall survival (OS) rates of the entire cohort at 12 and 24 months from ALL diagnosis was 49% and 25%, respectively. Most patients (n = 23, 72%) received prior chemo-/radio-therapy for their first malignancy (t-ALL) and only 9 (28%) did not (am-ALL). No significant difference was found in the incidence of B-/T- lineage ALL, extramedullary disease, blood count, and the rate of Philadelphia-positive ALL, nor in the rates of complete remission (P = 0.55) and OS (P = 0.97). This similarity, together with high incidence of family malignancy in both groups, raise the possibility that s-ALL patients may have an inherent predisposition to malignancies and a history of previous therapy may be of lesser importance in the pathogenesis of s-ALL.
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Affiliation(s)
- Chezi Ganzel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Sean Devlin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dan Douer
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Eytan M Stein
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abdulwahab A, Sykes J, Kamel-Reid S, Chang H, Brandwein JM. Therapy-related acute lymphoblastic leukemia is more frequent than previously recognized and has a poor prognosis. Cancer 2011; 118:3962-7. [PMID: 22180297 DOI: 10.1002/cncr.26735] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/07/2011] [Accepted: 09/08/2011] [Indexed: 01/02/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Amal Abdulwahab
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada
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Cho J, Hur M, Moon HW, Yun YM, Lee CH, Lee HG. A case of therapy-related ALL with MLL gene rearrangement following treatment of breast cancer. Korean J Lab Med 2010; 30:255-9. [PMID: 20603585 DOI: 10.3343/kjlm.2010.30.3.255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
ALL with MLL gene rearrangement secondary to chemotherapy has been rarely reported. We report a case of therapy-related ALL (t-ALL) with MLL gene rearrangement in a patient who had undergone treatment for breast cancer. A 60-yr-old woman with breast cancer underwent breast-conserving surgery followed by 6 cycles of adjuvant chemotherapy (cyclophosphamide, epirubicin, and fluorouracil) and radiation therapy (dose, 5,040 cGy to the left breast and a 1,000 cGy boost to the tumor bed). A follow-up examination performed 14 months after the chemotherapy revealed no evidence of breast malignancy. However, the patient's complete blood cell count indicated acute leukemia: white blood cell count, 174.1 x 10(9)/L with 88% blasts; Hb level, 12.5 g/dL; and platelet count, 103.0 x 10(9)/L. Examination of the bone marrow aspirate smear revealed a high percentage of blasts (85.1% of all nucleated cells); the blasts showed a pro-B immunophenotype and were positive for CD19, CD79a, HLA-DR, CD34, and terminal deoxynucleotidyl transferase (TdT). Cytogenetic and FISH analyses revealed t(4;11)(q21;q23) and MLL gene rearrangement, respectively. The patient received induction chemotherapy with cyclophosphamide, vincristine, doxorubicin, and dexamethasone and achieved complete remission. Following consolidation chemotherapy, she underwent allogenic peripheral blood stem cell transplantation and has been clinically stable. To our knowledge, this is the first reported case of t-ALL with MLL gene rearrangement following treatment of breast cancer in Korea.
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Affiliation(s)
- Jinhee Cho
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
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Li JM, Shen Y, Wu DP, Liang H, Jin J, Chen FY, Song YP, Song EYP, Qiu XF, Hou M, Qiu ZC, Shen ZX. Aclarubicin and low-dose Cytosine arabinoside in combination with granulocyte colony-stimulating factor in treating acute myeloid leukemia patients with relapsed or refractory disease and myelodysplastic syndrome: a multicenter study of 112 Chinese patients. Int J Hematol 2006; 82:48-54. [PMID: 16105759 DOI: 10.1532/ijh97.a10424] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
One hundred twelve patients with geriatric acute myeloid leukemia (AML), refractory or relapsed AML, or myelodysplastic syndrome and refractory anemia with excess of blasts in transformation (MDS-RAEBt) were entered into this study to receive CAG (aclarubicin and low-dose cytosine arabinoside [Ara-C]in combination with granulocyte colony-stimulating factor [G-CSF]) with the objective of evaluating the efficacy and tolerance of this regimen. Low-dose Ara-C was given subcutaneously at a dosage of 10 mg/m2 every 12 hours on days 1 to 14. Aclarubicin was administered intravenously at a dosage of 14 mg/m2 per day on days 1 to 4 (CAG regimen A) or 7 mg/m2 on days 1 to 8 (CAG regimen B). Recombinant G-CSF was given subcutaneously at a dosage of 200 3g/m2 per day on days 1 to 14. We demonstrated comparable overall complete remission rates for the 4 groups of patients: 30.8% (8/26) in the elderly patients, 48.4% (30/62) in the refractory AML patients, 44.4% (8/18) in the relapsed AML patients, and 38.5% (5/13) in the MDS-RAEBt patients. Of the 52 patients followed up, the 12-month progression-free survival (PFS) and overall survival (OS) rates estimated by the Kaplan-Meier method were 40.73% 3 8.15% and 42.85% 3 8.23%, respectively. The median PFS and OS times were 9.0 3 2.2 months and 11.0 3 1.6 months, respectively. Toxic effects were very rare and mainly consisted of neutropenia and thrombocytopenia due to myelosuppression; approximately 70% to 80% of patients had neutropenia or thrombocytopenia that exceeded National Cancer Institute grade II. Nonhematologic toxicities were not observed in this study. The CAG regimen seems promising, with acceptable toxicity, for the treatment of various categories of poor-prognosis AML and MDS-RAEBt.
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Affiliation(s)
- J M Li
- Department of Hematology, Shanghai Institute of Hematology, Ruijin Hospital affiliated with Shanghai Second Medical University, Shanghai, China
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