Clinical features and treatment outcome of childhood T-lineage acute lymphoblastic leukemia according to the apparent maturational stage of T-lineage leukemic blasts: A Children's Cancer Group Study Journal Article


Authors: Uckun, F. M.; Gaynon, P. S.; Sensel, M. G.; Nachman, J.; Trigg, M. E.; Steinherz, P. G.; Hutchinson, R.; Bostrom, B. C.; Sather, H. N.; Reaman, G. H.
Article Title: Clinical features and treatment outcome of childhood T-lineage acute lymphoblastic leukemia according to the apparent maturational stage of T-lineage leukemic blasts: A Children's Cancer Group Study
Abstract: Purpose: Leukemic cells from T-lineage acute lymphoblastic leukemia (ALL) patients are thought to originate from T-lymphocyte precursors corresponding to discrete stages of T-cell ontogeny. Here we sought to determine the influence of leukemic cell apparent maturational stage on treatment outcomes in pediatric T-lineage ALL. Patients and Methods: From 1983 through 1993, 407 pediatric T-lineage ALL patients were enrolled onto two sequential series of risk-adjusted treatment protocols of the Children's Cancer Group. In the current analysis, T-lineage ALL patients were immunophenotypically classified as follows: CD7(+)CD2(-)CD5(-) pro-thymocyte leukemia (pro-TL), CD7(+)(CD2 or CD5)(+)CD3(-) immature TL, and CD7(+)CD2(+)CD5(+) CD3(+) mature TL. Results: Similar induction outcomes of 91.4%, 97.1%, and 98.3% were obtained by the pro-, immature, and mature TL groups, respectively, Four-year event-free survival (EFS) was lower for pro-TL patients (57.1%; SD = 8.4%,) compared with immature and mature TL patients (68.5%; SD = 3.5%; and 77.1%; SD = 4.0%, respectively) with an overall significance of .05 (log-rank test) or .04 (log-rank trend test), Relative hazards rates (RHR) were 2.11 and 1.22 far pro-TL and immature TL versus mature TL, respectively, Highly significant differences were found for overall survival (P = .005, log-rank test; P = .009, log-rank trend test), Multivariate analysis confirmed that the prognostic influence of ontogeny grouping was independent of that of other prognostic factors, Conclusion: Leukemic cells of the pro-TL maturation stage identify a small subgroup of T-lineage ALL patients who have a significantly worse EFS outcome than patients whose cells are of a more mature stage of development. (C) 1997 by American Society of Clinical Oncology.
Keywords: experience; gene-expression; high-risk; prognostic-significance; precursors; cell; intensive therapy; acute lymphocytic-leukemia; unfavorable presenting features; hematopoietic progenitor; immunophenotypic subgroups
Journal Title: Journal of Clinical Oncology
Volume: 15
Issue: 6
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1997-06-01
Start Page: 2214
End Page: 2221
Language: English
ACCESSION: WOS:A1997XD97700006
PROVIDER: wos
PUBMED: 9196133
DOI: 10.1200/JCO.1997.15.6.2214
Notes: Article -- Source: Wos
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  1. Peter G Steinherz
    164 Steinherz