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Children with hyperdiploid but not triple trisomy (+4,+10,+17) acute lymphoblastic leukemia have an increased incidence of extramedullary relapse on current therapies: A single institution experience
Author(s) -
Sharathkumar Anjali,
DeCamillo Deborah,
Bhambhani Kanta,
Cushing Barbara,
Thomas Ronald,
Mohamed Anwar N.,
Ravindranath Yaddanapudi,
Taub Jeffrey W.
Publication year - 2008
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.21011
Subject(s) - medicine , trisomy , incidence (geometry) , lymphoblastic leukemia , gastroenterology , trisomy 8 , leukemia , surgery , cytogenetics , biology , chromosome , biochemistry , genetics , physics , gene , optics
To evaluate the outcome of children with high hyperdiploid acute lymphoblastic leukemia (hHDALL) treated at the author's institution. One hundred thirty‐five consecutive children with B‐precursor ALL were diagnosed between 1991 and 2002: 38 (28.1%) hHDALL and 97 (71.9%) non‐hHDALL. In the hHDALL group, 11/38 (28.9%) relapsed at a median interval of 2.8 years (range: 0.8–5.0 years) with 9/11 relapses occurring at the end or after the completion of therapy. Three (27.3%) relapses were isolated hematopoietic (BM), while eight (72.7%) were either isolated extramedullary (EM) relapses ( n = 6; Testis: 4; CNS: 2) or combined hematopoietic and extramedullary relapses ( n = 2; BM + CNS: 1; BM + Testis: 1). For the non‐hHDALL group, 29/97 (29.9%) relapsed. Unlike the hHDALL group, the non‐hHDALL group experienced hematopoietic relapses (62%; n = 18) more frequently than isolated extramedullary (27.5%; n = 8: Testis: 1; CNS: 7) or combined hematopoietic and extramedullary relapses (10.3%; CNS + BM: 3), with 24/29 (82.8%) of the relapses occurring on therapy. Relapses in hHDALL frequently involved EM sites ( P = 0.053). Presence of triple trisomy of +4,+10,+17 at diagnosis had a protective effect against relapse ( P < 0.05). Five‐year EFS for the hHDALL and non‐hHDALL patients was similar, 70.5 ± 7.5% and 66.4 ± 4.9%, respectively. Five‐year OS for the hHDALL patients was significantly higher than for the non‐hHDALL patients, 92 ± 4.5% vs. 74.1 ± 4.5%, P = 0.038. Biologically significant differences exist between relapse patterns of hHDALL and non‐hHDALL cases related to relapse sites and time periods when relapses occur. hDALL relapses continue to be chemo‐sensitive. Am. J. Hematol., 2008. © 2007 Wiley‐Liss, Inc.