Clinical features, molecular diagnosis, and treatment outcome of infants with leukemia in Taiwan

Abstract

Background. Infant leukemia is rare and quite distinct from other childhood leukemias. Differentiating between leukemia and transient myeloproliferative disorder (TMD) in phenotypically normal infants is sometimes difficult. The clinical features and molecular analyses for the fusion transcripts of mixed lineage leukemia (MLL) gene rearrangement in infant leukemia have not been well documented in the Chinese population. Procedure. Forty-five consecutive infants diagnosed with leukemia between 1995 and 2007 in a tertiary medical center in Taiwan were studied. Acute lymphoblastic leukemia (ALL) was diagnosed in 23 infants, acute myeloid leukemia (AML) in 21 (including TMD in 4), and juvenile myelomonocytic leukemia (JMML) in 1. Results. The median white count at diagnosis was higher in ALL than in AML (154.4 × 10 9 /l vs. 58.3 × 10 9 /l, P = 0.05). Chromosome 11q23/MLL abnormalities were present in 77% of ALL and 31% of AML. The 5-year event-free survival (EFS) in infant ALL and AML showed no difference (18% vs. 12%, respectively). The only independent predictor of an adverse prognosis among infants diagnosed with ALL was high presenting white count ≥ 100 × 10 9 /l (P = 0.05). However, no factor was associated with an adverse outcome for infants with AML. Conclusions. The molecular assessments and prognostic factors of infant leukemia in Taiwan mirror those in developed Western countries. Continued molecular investigations and development of more effective therapies are needed.

Mutational status of NRAS, KRAS, and PTPN11 genes is associated with genetic/cytogenetic features in children with B‐precursor acute lymphoblastic leukemia

“…Because KRAS was strongly associated with the specific genetic subtypes with prognostic significance, it was not an independent predictor for outcomes in the multivariate analysis. We had reported that KMT2A ‐rearranged infant ALL had a high relapse rate and poor treatment outcome, which was in agreement with the study of Driessen et al . KRAS mutations were associated with KMT2A ‐rearranged infant ALL, and therefore, contributed to an unfavorable prognostic factor in our study.…”

Survival and risk of relapse of acute lymphoblastic leukemia in a Mexican population is affected by dihydrofolate reductase gene polymorphisms

“…Immunophenotype has been considered as the most important prognostic factor impacting the therapeutic strategy. The pre-B ALL and the immature T-cell precursor are generally associated with a poorer prognosis (30). Two studies have shown that the Hispanic population has a high frequency of B-cell precursor immunophenotype (31,32).…”

MLL-SEPTIN gene fusions in hematological malignancies

“…However, and at least for AML, it appears that the prognostic effect of an MLL rearrangement could depend on the particular translocation partner involved. Indeed, several studies in children and adults with MLL-MLLT3 AML have shown superior event free and overall survival as compared to patients with other MLL rearrangements (Mrózek et al, 1997;Swansbury et al, 1998;Chen et al, 2010, Burnett et al, 2011. In contrast, AML patients with an MLL-MLLT10 have been shown to have a poor outcome in some studies (Dreyling et al, 1998) but superior long-term survival in others (Lillington et al, 1998;Chen et al, 2010;Burnett et al, 2011).…”