Influence of Karyotype on Outcome of Allogeneic Bone Marrow Transplantation for Adults with Precursor B-Lineage Acute Lymphoblastic Leukemia in First or Second Remission

Lee, Seok; Kim, Dong Wook; Kim, Yoo Jin; Min, Chang Ki; Lee, Jong Wook; Park, Eun Joung; Park, Yoon Hee; Min, Woo Sung; Kim, Chun Choo

Abstract

BACKGROUND: The discrepancy of therapeutic outcome between pediatric and adult patients with acute lymphoblastic leukemia (ALL) can be attributed in part to the higher frequency of adverse genetic abnormalities in adults. Several features such as age, leukocyte count, karyotype, and the rapidity of leukemic cell clearance have been noted to influence outcome of adult ALL in chemotherapy setting. However, the prognostic relevance of these factors has not been definitely evaluated in allogeneic BMT setting.
METHODS
A total of 41 consecutive adults with precursor B-lineage ALL who had a successful karyotype and treated with allogeneic BMT while in first or second complete remission (CR) were entered onto the study. Cases known to be t(9;22) or t(4;11) were classified as unfavorable karyotype.
RESULTS
There were 21 males and 20 females with median age 27 (range, 15~43) years. The distribution of FAB types was as follows : L1 26 cases (63.4%), L2 15 cases (36.6 %). Unfavorable karyotypes were identified in 12 patients (29.3%). Disease status at the time of transplant was first CR (n=37) or second CR (n=4). With a median follow-up of 26 months (range, 7~65 months), the probability of disease-free survival (DFS) was 66.5% and 49.9% at 2 and 5 years, respectively. In univariate analyses, characteristics predicting for worse DFS were FAB type (L2), pretransplant status (second CR) and unfavorable karyotype. Further multivariate analysis showed that the most powerful predictive factor for DFS was karyotype (P<0.01).
CONCLUSION
Our clinical data shows that karyotype is the most important prognostic factor in adult precursor B-ALL after allogeneic BMT.