Precursor B-acute lymphoblastic leukemia occurring in patients with a history of prior malignancies: is it therapy-related?
Precursor B-acute lymphoblastic leukemia occurring in patients with a history of prior malignancies: is it therapy-related?
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DOI：
10.3324/haematol.2011.057752
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发表时间：
2012-06-01
期刊：
影响因子：
--
通讯作者：
Wang, Sa A.
中科院分区：
文献类型：
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作者：
Tang, Guilin;Zuo, Zhuang;Wang, Sa A.
Backgroundprecursor B-急性淋巴细胞白血病发生在患者的恶性肿瘤的历史是罕见的，这种情况是不是很好地understood.Design and MethodsA回顾性审查457成人前体B-急性淋巴细胞白血病在我们的医院治疗确定44（9.6%）患者先前的恶性肿瘤。这组患者的临床和遗传特征进行了比较，他们的同行与新发疾病和先前的放化疗therapy.ResultsThirty的关系44例（6.2%）患者接受细胞毒性治疗，而14例患者没有。前一组显示从先前的恶性肿瘤到前体B急性淋巴细胞白血病发作的时间间隔显著更短（36个月对144个月; P = 0.002）。与413例初治病例相比，接受拓扑异构酶II抑制剂和/或烷化剂治疗的患者中t（4;11）（q21;q23）（P < 0.001）和亚二倍体（P = 0.009）伴5、7或17号染色体丢失的频率显著增高。相比之下，Philadelphia阳性和正常核型在未接受化疗或仅接受局部放疗或核苷类似物的患者中更常见。前体B-急性淋巴细胞白血病患者先前的恶性肿瘤和放化疗年龄较大，有较低的完全缓解率，并表现出较低的生存在单变量，但不是多变量analys.ConclusionsThe数据支持的解释，治疗相关的前体B-急性淋巴细胞白血病确实发生。特别是，与t（4;11）（q21;q23）或-5，-7，-17亚二倍体相关的病例可能与治疗相关，预后不良。这些患者的不良结局可能归因于该组患者中发现的高风险细胞遗传学异常。
BackgroundPrecursor B-acute lymphoblastic leukemia occurring in patients with a history of malignancies is uncommon, and this condition is not well understood.Design and MethodsA retrospective review of 457 adults with precursor B-acute lymphoblastic leukemia treated at our hospital identified 44 (9.6%) patients with prior malignancies. The clinical and genetic characteristics of this group of patients was compared with those of their counterparts with de novo disease and the relationship with prior chemoradiation therapy was assessed.ResultsThirty of 44(6.2%) patients received cytotoxic therapies, whereas 14 patients did not. The former group showed a significantly shorter interval from prior malignancy to onset of precursor B-acute lymphoblastic leukemia (36 versus 144 months; P = 0.002). Compared with 413 de novo cases, the frequencies of t(4;11)(q21;q23) (P < 0.001) and hypodiploidy (P = 0.009) with loss of chromosome 5, 7 or 17 were significantly higher in patients who received topoisomerase II inhibitor and/or alkylating agents. By contrast, Philadelphia-positive and normal karyotype were more frequent in patients who either did not receive chemotherapy or received only local radiation or nucleoside analogs. Patients with precursor B-acute lymphoblastic leukemia following prior malignancies and chemoradiation were older, had a lower complete remission rate and showed an inferior survival in univariate, but not multivariate analysis.ConclusionsThe data support the interpretation that therapy-related precursor B-acute lymphoblastic leukemia does occur. In particular, cases associated with t(4;11)(q21;q23) or hypodiploidy with -5, -7, -17 are likely to be therapy-related and have a poor prognosis. The inferior outcome of these patients may be attributable to the high-risk cytogenetic abnormalities that are found in this group of patients.