Prognostic implications of cytogenetic studies in an intensively treated group of children with acute lymphoblastic leukemia

Abstract

We assessed the prognostic significance of leukemia cell cytogenetics by analyzing bone marrow aspirates obtained at time of diagnosis in 165 children on a single protocol for acute lymphoblastic leukemia (ALL). These children were assigned to six mutually exclusive cytogenetic categories as follows: (1) hyperdiploid, with 50 or more chromosomes (n = 35); (2) hyperdiploid, with 47 to 49 chromosomes (n = 11); (3) diploid (n = 42); (4) pseudodiploid (n = 34); (5) hypodiploid (n = 9); and (6) insufficient data (n = 34). At a median follow-up of 5 years, there were no statistically significant differences between any of these cytogenetic categories in either event-free or overall survival. Those children with chromosomal translocations (n = 26) appeared to fare the same as those lacking translocations (n = 105). The absence of karyotypic prognostic significance was observed not only within the overall group, but also when the results were stratified by standard- risk and high-risk status. Of the specific structural chromosome changes that we studied, only the Philadelphia chromosome (Ph) appeared to confer a poor prognosis, although there were too few such cases to achieve statistical significance. Although we did not detect the event- free survival differences that have been described previously in hyperdiploid, hypodiploid, and pseudodiploid childhood ALL, our findings must be viewed as preliminary given the small number of children in some of the cytogenetic categories. We think that the prognostic implications of these cytogenetic features might have been nullified by improvements in therapy.

Prognostic impact of bone marrow karyotype in childhood acute lymphoblastic leukaemia: Swedish experiences 1986‐91

“…It therefore seems that risk classification based on traditional clinicohematologic parameters is sufficient in the majority of cases. Our results may be at odds with the results of earlier large studies of childhood ALL in which older and less intensive therapeutic regimens were used, but more recent studies from Germany (25) and the United States (13,24) have reached conclusions similar to ours.…”

The Role of Prognostic Features in the Treatment of Childhood Acute Lymphoblastic Leukemia

“…In general this cytogenetic finding is considered an indication for allogeneic bone marrow transplantation in first remission. Whereas many other cytogenetic findings have lost prognostic significance with improvements and intensification of therapy, the Ph chromosome has maintained its adverse prognostic implications [41].…”

Hyperdiploidy arising from near‐haploidy in childhood acute lymphoblastic leukemia

“…A hyperdiploid karyotype is observed in 23 to 39% of newly diagnosed children with acute lymphoblastic leukemia (ALL) (Kaneko et al, 1982;Heerema et al, 1985;Prigogina et al, 1988;Pui et al, 1988;Fletcher et al, 1989Uckun et al, 1989. These patients are generally divided into subgroups, namely, those with a chromosome number of 4749 and those with 2 50 chromosomes.…”