Concerning response to treatment and overall prognosis, all patients experienced a complete response to induction therapy with rapid decrease in leukocytosis and resolution of extramedullary involvement under corticosteroid therapy. MRD, when applicable, was found negative at the end of induction, underlying high sensitivity to chemotherapy. This high chemosensitivity contrasted with the high incidence of relapse (occurring in three of our cases) and poor overall prognosis. This finding underlines the importance of quick identification of this rearrangement to propose treatment adaptation to high-risk groups, including allogeneic marrow transplantation consideration before facing potentially chemoresistant relapse.In summary, we describe here five cases of mature 'sIg þ ' B-ALL with non FAB-L3 morphology displaying 11q23-MLL rearrangement, and especially t(9;11), occurring in young children with a poor prognosis and requiring treatment intensification.
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