ABSTRACT
Azacitidine (AZA) is a DNA hypomethylation agent administered in myeloid neoplasms; however, there is still a lack of established predictors of response. We studied 113 patients with myelodysplastic syndromes (n = 85) or acute myeloid leukemia (n = 28) who received AZA to assess the predictive value on response of clinical features, cytogenetics, and molecular markers. Overall, 46 patients (41%) responded to AZA. Platelet doubling after the first AZA cycle was associated with a better response (68% vs. 32% responders, P = 0.041). Co-occurrence of chromosome 7 abnormalities and 17p deletion was associated with a worse response (P = 0.039). Pre-treatment genetic mutations were detected in 98 patients (87%) and methylation of CDKN2B and DLC-1 promoters were detected in 50 (44%) and 37 patients (33%), respectively. Patients with SF3B1 mutations showed a better response to AZA (68% vs. 35% responders, P = 0.008). In contrast, subjects with mutations in transcription factors (RUNX1, SETBP1, NPM1) showed a worse response (20% vs. 47% responders, P = 0.014). DLC-1 methylation pre-treatment was associated with poor clinical features and its reduction post-treatment resulted in a better response to AZA in MDS patients (P = 0.037). In conclusion, we have identified several predictors of response to AZA that could help select the best candidates for this treatment.
Subject(s)
Azacitidine/administration & dosage , Cyclin-Dependent Kinase Inhibitor p15 , DNA Methylation/drug effects , DNA, Neoplasm , GTPase-Activating Proteins , Myelodysplastic Syndromes , Promoter Regions, Genetic , Tumor Suppressor Proteins , Aged , Aged, 80 and over , Chromosome Deletion , Chromosomes, Human, Pair 7/genetics , Chromosomes, Human, Pair 7/metabolism , Cyclin-Dependent Kinase Inhibitor p15/genetics , Cyclin-Dependent Kinase Inhibitor p15/metabolism , DNA, Neoplasm/genetics , DNA, Neoplasm/metabolism , Disease-Free Survival , Female , GTPase-Activating Proteins/genetics , GTPase-Activating Proteins/metabolism , Humans , Leukemia, Myeloid, Acute/drug therapy , Leukemia, Myeloid, Acute/genetics , Leukemia, Myeloid, Acute/metabolism , Leukemia, Myeloid, Acute/mortality , Male , Middle Aged , Myelodysplastic Syndromes/drug therapy , Myelodysplastic Syndromes/genetics , Myelodysplastic Syndromes/metabolism , Myelodysplastic Syndromes/mortality , Nucleophosmin , Survival Rate , Tumor Suppressor Proteins/genetics , Tumor Suppressor Proteins/metabolismABSTRACT
BACKGROUND AND OBJECTIVE: T-cell acute lymphoblastic leukemia (ALL) includes 4 immunological subtypes: pro-T, pre-T, thymic or cortical and mature. In some studies, pro-T and mature subtypes have a poor prognosis. The objective of this study was to describe the clinical characteristics, the result of treatment and the prognosis of the immunological subtypes of T-cell ALL in 81 adult patients included in 2 protocols of the Spanish PETHEMA group (ALL-96 and ALL-93). PATIENTS AND METHOD: Between 1993 and 2003, 81 adult patients from 22 Spanish hospitals were included in two PETHEMA protocols: ALL-96 for standard-risk patients, and ALL-93 for high- risk patients. The main clinical and biological parameters as well as the rate of response to treatment, the frequency of complete remission , disease free survival and overall survival were compared in each T-cell ALL subtype. RESULTS: Of the 64 evaluable patients the distribution of the immunological subtypes was: 3 pro-T, 17 pre-T, 22 thymic or cortical and 22 mature. Patients with mature T-ALL had higher frequency of central nervous system involvement and myeloid antigen expression than those of the remaining subgroups. Patients with mature T-cell ALL had a slow rate of response to treatment in comparison with patients wit pre-T and mature T-cell ALL but this did not translate to significant differences in frequency of complete remission (77% vs 94%), disease free survival (42% vs 46%) and overall survival (29% vs 47%). CONCLUSIONS: Although patients with mature T-cell ALL had a slow rate of response to treatment and their survival tended to be shorter, in the present study there were no statistically significant differences in the prognosis of the different subtypes of T-cell ALL.
Subject(s)
Leukemia-Lymphoma, Adult T-Cell/mortality , Adolescent , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Female , Humans , Immunophenotyping , Leukemia-Lymphoma, Adult T-Cell/drug therapy , Leukemia-Lymphoma, Adult T-Cell/pathology , Male , Middle Aged , PrognosisABSTRACT
Fundamento y objetivo: La leucemia aguda linfoblástica (LAL) de fenotipo T incluye 4 subtipos inmunológicos: pro-T, pre-T, tímica o cortical y madura. En algunos estudios, los subtipos LAL pro-T y maduro tienen un peor pronóstico. El objetivo de este estudio ha sido describir las principales características clínicas, los resultados del tratamiento y el pronóstico de los subtipos inmunológicos de LAL-T en 81 pacientes adultos incluidos en 2 protocolos del grupo PETHEMA (LAL-96 y LAL-93). Pacientes y método: Entre 1993 y 2003, se incluyó en 2 protocolos de PETHEMA a 81 pacientes adultos de 22 hospitales españoles: LAL-96 para pacientes de riesgo estándar y LAL-93 para pacientes de alto riesgo. Se comparó los principales parámetros clínicos y biológicos iniciales de cada subgrupo de LAL-T, así como la rapidez en la respuesta al tratamiento, la tasa de remisión completa, la supervivencia libre de enfermedad y la supervivencia global. Resultados: De los 64 pacientes evaluables, la distribución de los subtipos inmunológicos fue: 3 pro-T, 17 pre-T, 22 tímica o cortical y 22 madura. Los pacientes con LAL-T madura presentaron afección inicial del sistema nervioso central y marcadores mieloides con mayor frecuencia que el resto de los pacientes. Los pacientes con LAL-T madura tuvieron una respuesta significativamente más lenta al tratamiento que los que presentaban LAL-T pre-T y cortical, pero ello no se tradujo en diferencias significativas en la tasa de remisión completa (el 77 frente al 94%) supervivencia libre de enfermedad (el 42 frente al 46%) y la supervivencia global (el 29 frente al 47%). Conclusiones: Aunque los pacientes con LAL-T madura respondieron más lentamente al tratamiento y su supervivencia tendió a ser más corta, en el presente estudio no se encontraron diferencias estadísticamente significativas en el pronóstico de los diferentes subtipos de LAL-T
Background and objective: T-cell acute lymphoblastic leukemia (ALL) includes 4 immunological subtypes: pro-T, pre-T, thymic or cortical and mature. In some studies, pro-T and mature subtypes have a poor prognosis. The objective of this study was to describe the clinical characteristics, the result of treatment and the prognosis of the immunological subtypes of T-cell ALL in 81 adult patients included in 2 protocols of the Spanish PETHEMA group (ALL-96 and ALL-93). Patients and method: Between 1993 and 2003, 81 adult patients from 22 Spanish hospitals were included in two PETHEMA protocols: ALL-96 for standard-risk patients, and ALL-93 for high- risk patients. The main clinical and biological parameters as well as the rate of response to treatment, the frequency of complete remission , disease free survival and overall survival were compared in each T-cell ALL subtype. Results: Of the 64 evaluable patients the distribution of the immunological subtypes was: 3 pro-T, 17 pre-T, 22 thymic or cortical and 22 mature. Patients with mature T-ALL had higher frequency of central nevous system involvement and myeloid antigen expression than those of the remaining subgroups. Patients with mature T-cell ALL had a slow rate of response to treatment in comparison with patients wit pre-T and mature T-cell ALL but this did not translate to significant differences in frequency of complete remission (77% vs 94%), disease free survival (42% vs 46%) and overall survival (29% vs 47%). Conclusions: Although patients with mature T-cell ALL had a slow rate of response to treatment and their survival tended to be shorter, in the present study there were no statistically significant differences in the prognosis of the different subtypes of T-cell ALL
