Acute Lymphoblastic and Myeloid Leukemia Pre- and Post-Disease Form

Mary Eapen MD, MS

Acute Lympoblastic Leukemia

Acute Lymphoblastic Leukemia ƒ SEER ƒ Age-adjusted incidence rate 1.6 per 100,000 men and women per year ƒ ~60% were diagnosed under age 20 ƒ Overall survival ~ 65% ƒ Treatment py ± irradiation ƒ Chemotherapy ƒ Hematopoietic cell transplantation

Classification of ALL ƒ Thi This h has prognostic ti implications i li ti ƒ Immunophenotype ƒ Determine cell lineage ƒ Cytogenetics ƒ Genetic alteration/molecular marker ƒ This information is used to determine intensity of treatment so as to offer the best chance of survival

Classification - Cell lineage ƒ Immunophenotying is determined by flow cytometry ƒ Important in diagnostic evaluation ƒ Allows classification of ALL ƒ B-lineage (B lymphocytes) ƒ T-lineage (T lymphocytes) ƒ B-lineage = pre-B and mature B ALL ƒ T-lineage = T cell

Classification ƒ Cytogenetics ƒ Prognostic significance ƒ Common abnormalities ƒ Translocations: (9;22), (4;11)(1;19) (8;14) (4;11)(1;19), (8;14), (10;14) ƒ Structural abnormalities: 9p, 6q, 12p ƒ Number of chromosomes in cell ƒ Hypo, Hypo hyper hyper, tri/tetra diploid

Cytogenetics y g Cytogenetic abnormality t(9;22)

g Genetic alteration Prognosis BCR/ABL

Unfavorable

t(4;11)

AF4/MLL

Unfavorable

t(1;19)

PBX/E2A

Unfavorable

t(12;21)

TEL/AML1

Favorable

Hyperdiploid >50

__

Favorable

Hypodiploid ≤45

__

Unfavorable

Prognostic Features ƒ National Cancer Institute risk group ƒ Age at diagnosis and WBC count ƒ Good risk: ƒ Age A 1 1-10 10 years and d WBC 4 weeks of induction therapy to achieve 1st remission signals “high risk” ƒ Minimal residual disease (MRD) ƒ At end of induction also signals “high risk”

Indications for HCT ƒ 1st CR ƒ t(9;22), hypodiploidy, induction failure, >4 wks to 1st CR ƒ 2ndd CR C ƒ Bone marrow recurrence