Secondary acute lymphoblastic leukaemia is constitutional and probably not related to prior therapy
Secondary acute lymphoblastic leukaemia is constitutional and probably not related to prior therapy
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DOI：
10.1111/bjh.13386
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发表时间：
2015-07-01
影响因子：
6.5
通讯作者：
Tallman, Martin S.
中科院分区：
文献类型：
--
作者：
Ganzel, Chezi;Devlin, Sean;Tallman, Martin S.
关于继发性急性淋巴细胞白血病（s-ALL）知之甚少。这项回顾性分析研究了1994年至2013年期间在一家中心接受治疗的s-ALL患者队列，同时比较了治疗相关ALL（t-ALL）和既往恶性ALL（am-ALL）患者。确定了32例s-ALL患者。成人ALL的总发病率为94%，而T细胞s-ALL罕见（s-ALL的12%）。两次恶性诊断之间的中位时间间隔为53年（范围：01 - 28）。与以前的报道相反，大多数s-ALL是CD10+，没有KMT2A（MLL）异常。整个队列在ALL诊断后12个月和24个月的总生存率（OS）分别为49%和25%。大多数患者（n = 23，72%）既往接受过首次恶性肿瘤（t-ALL）的化疗/放疗，仅9例（28%）未接受（am-ALL）。两组在B/T系ALL、髓外疾病、血细胞计数、费城阳性ALL的发生率、完全缓解率（P = 0.55）和OS率（P = 0.97）方面均无显著差异。这种相似性，加上两组家族性恶性肿瘤的高发病率，提高了s-ALL患者可能具有恶性肿瘤的固有易感性的可能性，既往治疗史在s-ALL的发病机制中可能不太重要。
Very little is known about secondary acute lymphoblastic leukaemia (s-ALL). This retrospective analysis studied a cohort of s-ALL patients treated at a single centre between 1994 and 2013, while comparing therapy-associated ALL (t-ALL) and antecedent malignancy ALL (am-ALL) patients. Thirty-two patients with s-ALL were identified. The overall incidence was 94% among ALL adults while T-cell s-ALL was rare (12% of s-ALLs). The median time interval between two malignant diagnoses was 53years (range: 01-28). In contrast to previous reports, most of the s-ALLs were CD10+ and without KMT2A (MLL) abnormalities. The overall survival (OS) rates of the entire cohort at 12 and 24months from ALL diagnosis was 49% and 25%, respectively. Most patients (n=23, 72%) received prior chemo-/radio-therapy for their first malignancy (t-ALL) and only 9 (28%) did not (am-ALL). No significant difference was found in the incidence of B-/T- lineage ALL, extramedullary disease, blood count, and the rate of Philadelphia-positive ALL, nor in the rates of complete remission (P=055) and OS (P=097). This similarity, together with high incidence of family malignancy in both groups, raise the possibility that s-ALL patients may have an inherent predisposition to malignancies and a history of previous therapy may be of lesser importance in the pathogenesis of s-ALL.