Good outcome for very high risk adult B-cell acute lymphoblastic leukaemia carrying genetic abnormalities t(4;11)(q21;q23) or t(9;22)(q34;q11), if promptly submitted to allogeneic transplantation, after obtaining a good molecular remission

Matteo Parma, Clara Viganò, Monica Fumagalli, Federica Colnaghi, Arianna Colombo, Federica Mottadelli, Vincenzo Rossi, Elena Elli, Elisabetta Terruzzi, Angelo Belotti, Giovanni Cazzaniga, Enrico Maria Pogliani, Pietro Pioltelli

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Objectives: Acute lymphoblastic leukaemia (ALL) carrying t(9;22) or t(4;11) genetic abnormalities represents a very high risk subtype of disease (VHR-ALL). Hematopoietic stem cell transplantation (HSCT) remains the best curative option not only for t(4;11) ALL, but also for t(9;22) ALL in the tyrosin-kinase inhibitors era. In the last years, low molecular level of minimal residual disease (MRD) before HSCT was reported as one of the best favourable indexes for survival in ALL. Here we observed that even these patients can show a favourable outcome if submitted to HSCT with very low MRD. Methods: We considered 18 consecutive VHR-ALL patients eligible to HSCT. 16 of them were transplanted in first remission, as soon as possible, employing myelo-ablative conditioning regimens. Molecular MRD has been evaluated before and after HSCT. Results: Immediately before HSCT, MRD revealed: complete molecular remission (MRDneg) for five patients, and a level -3 for seven patients. 100 days after HSCT we had: MRDneg for seven patients and a decrease for all the others after HSCT. After the tapering of immunosuppressive drugs, 13 patients reached the MRDneg in a median time of 8 months (range 3-16). In the intention to treat analysis, 14/18 patients are alive and disease free at the date of analysis. Overall survival and event free survival is of 78% and 66% respectively, with an average follow-up of 45 months (range 6-84) since HSCT. Conclusion: Early transplantation with low MRD level seems to be correlated with a favourable outcome also in VHR-ALL.

Original languageEnglish
Article numbere2015041
JournalMediterranean Journal of Hematology and Infectious Diseases
Volume7
Issue number1
DOIs
Publication statusPublished - 2015

ASJC Scopus subject areas

  • Hematology
  • Infectious Diseases

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